20372 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: . -------- - - ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..s .. ........ - 1 --------- ----------------------------- ---------------- (Complete in Duplicate Date Issued ............. ........... .. ... This Permit Ex fres 1 Year From Date Issued _ .fdr � � Q(o•- 2�Co -Z Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work herein desc ibed. This application is made in corn ce with C�un -Qrdir�ance No. 549. ARTI1WP. r 77 JOB ADDRESS AND LOC TI N .1�)M - -- Jam- -`------- -----0E-------`�----�-`------•.�---_------------- Owner's ------ .. Owner's Name f} L� �J /'� 1K�> ----- ------------------------- ---- ------ ------ Phone-----------------------•---•-------- Address............._ .r -�. 1...l....- Q K-------- -----------4.._TO1 QP.r-------------------------------•---------•------------..----------------•- Contractor's Name--M-.J � ('� - .. -•---------- ----------------:-------- -----------------------------•----- ------------------ Phone----------------------------------- Installation will serve: Residence Fet Apartment+House ❑ Commercial ❑ Traii r Court ❑ Motel ❑ Other ❑ Number of livingunits: _1-.---- Number of bedrooms-3----- Number of baths *s.Lot size -_-1_�9Z a-a--1144—_------------ Wafer Supply:Supply: Public system [r�ommunity system ❑ Private ❑.Depth to Water Table /Zit. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- -------- ) No-:��New#Construction: Yes R--No ❑ FHA/VA: Yes [?�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t �4 -. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well -_W__'-_Distance from foundation..../ ---------Material--CQ Csir -- ----------. No. of compartments_ --,------_-Size_- ilr/0-X •---Liquid depth----- -Z__._gCapacity----1900---- Disposal Field: Distance from nearest well.__.. - r_Distance from foundation---/D- -.-_----Distance to nearest lot line---43 of lines---------- ------------------Length of each line--- --Width!of french--------Z '.0._ _. -.--- Type of filter materia l__-0C .-Depth of filter material-.-.-- _-.Total lengtb---------%3' _-'r------------------- Seepage ------------------Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line----------------_ ❑ Number of pits-- -------------- Lining material-----..---.- Size: Diameter-------------- -- Depth-------------:------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material--------- -------------------------- ❑ Size: Diameter- --- --------------- ----------------Depth----------------------------------------------1-----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------- ..-----.----.--Distance from ynearest building------------------------------------------ ❑ Distance to nearest lot line-- ---------------------------------------- ----------------------------------------------------------------------------------------------- i Remodeling and/or repairing {describe):---- ---1[Y--------p-R-Q.PO-5f=D------- ------1>1s-mlC�• I----- -- _ ---------------------------------------- ---------- '= ---------------------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify thaf-I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat I w ,.and rules and regulation of the San Joaquin Local Health District. i (Signed)------ + �.___-Owner and/or Contractor] _1 x� -------_- = ( / By:-----------------------------------------------------------------------------------------------------------------------------: -----(Title)-------------------- ----- --- ---------------..- ---- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). T FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY---rtQ------------------------------------------------------------------------- DATE----3_7,2_.4.6- --------- REVIEWEDBY----------------------------- ------------------------------------------------------- DATE--------7------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------- --------- -------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------- --- --- --- ---------- ---------------------------------------------------------------------- ------------------------------------- ------------ i'�-PF `sQ INSYI 7T = Lr_N -------FR°^^-----�R —------- ! -------- ------------------------------------------------------ ------------ ------ ------------- ---------------------------------------_.-------------- -------- -------------- ------ ----------------------- �--� FINAL INSPECTI - ----- -- --- ---- --- Date---.... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street + $ 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California 1 ��