17940 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------ -- - APPLICATION FOR SANITATION PERMIT Permit No. .___1q_..7..-.Z`_ -_--_-_-- --------------------- (Complete in Duplicate) Date Issued ..{ �- __� -r f- - -U�(. 4•��,.__�- - This Permit Expires 1 Year From Date Issued _og W Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work.herein deescrried- l=" l+r r 1 c-r'! This application is mad i compliance with County Ordinance No. 549. J08 ADDRESS AND LOCATION--------------- fT �� pQ. - Q f ' Owner's Name ----- -��_ _-.. -- N- --- -=-------------------- ----------- --- -- Phone---- -------------------------- - IAddress----------------�E----- X--------��Q--- ..... '------------------- . -- � - -•-- ---- ---- � --• - • -- e Commercial 4-------------•-------•----- • -------•---- Phone---•--_--------------------------- Contractor's Name--._--- ,�c�!_��-z�-•--- -------------- =--- Installation will serve: Residence [ Apar+ment Haus ❑ ❑'� Trailer Court ❑ Motel [I Other ❑ Number of living units: __�-__-- Number of bedrooms ,_7__ Number of baths;�Lcr size ---- - --- -----x--- 12 d Q---------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Waf?e*r Table f+• I Character of soil to a depth of 3 feet: Sand [ Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe E] Hardpan ❑ i Previous Application Made. (If yes,date____________________) No [ New Construction: Yes moo.❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION`AND SPECIFICATIONS: (No-septic.fank.-or,cesspool permitted if_public sewer.is available within 204 Septic T nk- Distance from nearest well___b.��--_Distanc /from foundation____--R2____-Mate�i I____ X, X- ------------- _ /� X_ -:_._Liquid`depth---- -- ----;�----Capacity--- N � o of compartments. ��' Size- __ _. -- C?_Q _ d Disposal Field: Distance from Irl`eares� w%'e i_6.�.�._-Distance from foundation___.__ ____Distance to nearest lot line p �- .. _ ` N�mber of lines-----__0_ ----- Q-- -----------Length off eaehmlate3r __-- SbY� ..Width hie length--- Seepage --.�� - of tr Type of filter material__R__._._C. p F f f t . Seepage Pit: Distance to nearest well-----_----------------Distance from foundation_----.------1____Distance to nearest lot line------------------ ❑ Number of pits---.------------------Lining material-.-------- ------------Size: Diameter --- -----------------Depth_---------------------------_---- t { � Cesspool: Ditance from nearest well_____.___._-.,_-Distance from foundation--------.....yi..__.Lining material______...__-__.____._____._______.-.�1 ' ElSize: Diameter--- ----��t----—--_-n___"_Depth_-__:-"--_ -_____ " - ---------- Liquid Capacity gals. Privy: Dist7nce,,,fro.m,Ynear,)est well------------------------___----------------------Distanq from nearest building-------------.____..._- ------•---- ❑ Distance to nearest lot line----------------------------------- ----------------------- -------------------------------------------------- -------------- Remodeling and/or r pairing (describe):------------------------------------------•------------------ rr----------------------------------------------- ------------------• ! ------------------------------------------------------------------------------_----------------------------------•---------------------------------- -------------------------------------------------- ------------------- ----------- I hereby certify that I have prep afed-this.application,and.that�.the work-work accordance with San Joaquin County ordinances, State laws, and rules and rggu t' ns of he.San Johquin Local Healthlpistric�t. I (Signed) !_._`_.--- --------- ------------------------------- }` -----.(Owner and/or Contractor) -..Tft BYE--------------------------------__------.------------.--------------. ,-.-.�:--:--_:-: _. ---------------------� � _ .. ------------- ---------------- (Plot ---- - - -- _--.r (Plot plan, showing size of lot, location: of system in relation to wells, buildings, etc., can be placed on reverse side). , .�,r,,.,,,,FOR DEPARTMENT USE ONLY f�1 APPLICATION ACCEPTED BY----- ,�--•__- _, �__ =' 'DATE------ --5� -�7-� ................. f C - - REVIEWED BY-------------------------------------- - -- ---------------------------------------- -------------------------- DATE----------------_- ------------------------------------ -- - - ------ ----- BUILDINGPERMIT ISSUED--------------------- --- ------------ DATE------------------------------------------------------------- Alterations and/or recommendations:---------- -- --------- -----------------------------------------•---------------•--------------------------------------- .1 ----------- ---------------- .. . _ - , ------------------------------- --------- = ------------------- ---- '�------- - - ---:.A 1 -------f ---- ----------------•-------------------------- ----------------•-------------- FINAL INSPEC -- --- ----- ------ --- --- Date f/ _..rr✓- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California l F.Rco. ��