21088 - Laserfiche WebLink

Home Browse Search

FOR OFFICE_US„E: - __"_-----_---__ ---- ------------- J APPLICATION FOR SANITATION PERMIT Permit' No. ..r21 ..r�� ' - -------------------------------- ---------------- (Complete in Duplicate) _._ ------.... This PermitEx ince 1 Year From Date Issued Date Issued ._ __ f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the"work herein described. This application is made in compliant with C -2-12-qounty Ordinance No. 549. -2-12-q --1210 -Q � JOB ADDRESS AND LOCATIO -----`��__----EL------ CJ = .SO J------------ Owner's Name---------------t/V 3 ------• -------------------------------------------------------------- --- �� h}"1?�E.( ~------------ Phone--= 3-_Z`f 2� Address------------------- 1-4- 1 Contractor's Name--- A__N,T',N a-N :_ _. _on1 --•--------------- Phone-------- -------------------------- Installation will serve: Residence :Ca-a-AparfinentDouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ :Other ❑ Number of living units: _ _I_._ Number of bedrooms ._-�_ _ Number of afhs .[_-_-_ Lot size ----A-cR.FA6 ___--_-•- Water Supply: Public system E] Community system ElPrivate Depth to Wafer Table �?sft. Character of soil to a depth of 3 feet: Sand-0 Gravel ❑ -San Loam ❑ Clay Loam Clay p dobe ❑ Hardpan I� Previous Application Made: {If Yes,-date___________________) No f New Cons+ruction: Yes ❑" No FHA/VA: Yes ❑ No 0_ -TYPE:OF INSTALLATION,AND.;SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) y - I Septic N " Distance fr'om.riearest well � CQC Distance from foundafion._ tgra fEr� No, of compartments_____________ -_-Size- c l x_ �-Liquid depth-_- —:--.-Capacity__—>_0 Z)_-. Disposal R ld: Distance from nearest well__.-:5_-6.__Disfance from foundation-----1 ______.Distance to nearest lot line---- Number t Length of each line___.�4__-`-- ��- -Width of trench_.-_ y_•11______________ Number of lines-1 --- - --------------•-- Type of filter maferial--RPCtc-----Depth of filter material____--117______-__-dotal length_____________ _-7___-'__ F- — - , } cepa it: Distance to dearest well-.-I©_©------Distance from foundation___l�__.�-_ Distance to nearest lot line..--f�--------____ � S Number of pits.-I------/----------.Lining material_A_QGK....Size: Diameter._.. . -_-_-. Depth--------2,$x-1`---70--- .914-, p � Cess Cesspool: Distance from nearest welL_____----------- __________Distance from foundation�-.__ -----------Lining Capacity_-_______-..-____-.__.___-._gals, 4 ❑ Size: Diameter--- - --- ----De th------------------------------ --- - - ----- --- q P Y Privy: Distance from nearest well_-----------------------------------------------Distance from nearest❑ building------_---------------------_____----- --. ==� " Distance to nearrest lot line________________________-__-_ --------------------------------- r.. f „ Remodeling and/or'siR'P algin9 descri1be ----- - ------------ -- =---------- I I _ : ________________________------------------ 4 W. ----------------------- xM------ -------------------------------------------------_____7____-_- -,_____-_____________-____--. __________-___________________________ S- __ ___. - --------------------- I hereby certify that I have prepared this application' and +hat the work will be done.in accordance with-S-an "Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 7, i (Signed) _ - ----- ---- _ _ - -�'+� --- - -- - ---- -8Y� er, tor) -- -- -- - ----. �---- ----------- ..._._....... ------------ •- --jTi+le] wand/or Contractor) ` �w u ntR^- (Plot plan, showing size of lot, location o m in relation to wells, buildings, e+c., can be placed e side). � on reverse FOR DEPARTMENT USE ONLY f APPLICATION-ACCEPTED BY----~..��-��`�' .:"--- - ------ ------------------------------------- -------- DATE------ REVIEWEDBY---- --------------------------- =------------------- ------------- -----------------------• -------------- DATEE---------- BUILDWG PERMIT ISSUED ----------------------------------------------—-------- ----------------------------- DATE-- = Alterations and/or recommendations'- r------------ 5----} -------------------------- --------- ------------------•----•---------------- ------------------------------ --------------------------------------------------- ' cb rJA f R --- !> � - -------------------------- ---------- -- - -------------------------------------- -- - ---- ---- -- -- ------------- - -------------------- ------------ --------=------------ 1 - ----------- Date FINAL INS CTION I_ . -. l��Q -_-- I 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton;California Lodi,California Manteca,California Tracy,California r