18825 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---- -- - ----- ---------------- APPLICATION AOR SANITATION PERMIT Permit No. ----- ---------- ---- ----------------------------------- (Complefe in Duplicate) ! -------------- This Permit Expires 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 compliance with County Ordinance No. 549. __V-t5 �,f JlOB DDRESS A LOCATION-- -•-- •-'------ � �� • �T 74441 - % f Owner's Name---A_)wa 0-. ..yow - ----------------------------�-�--------------------------------------------------_- Phone---------------------------- Address------....yre-m- ..................................................._.-_ Contractor's Name------ ro---,Zev,&�.,-�--------------------- ---- ------------------------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence ©—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l Number of living units: _/__ Number of bedrooms _ ._ Number of baths -/___ Lot size ---------------------------- I I Water Supply: Public system E] Community system [IPrivate Depth to Water Table _;� f"t. # Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ - i Previous Application Made: {If.yes,date-------_.._IC..___._I No [ New Construction: Yes ❑ No R1 FHA/VA: Yes ❑ No�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) � Q----_--.Mate i l � loll--------- Septic Tank: Distance from nearest well___®____Distance from foundetio ._-. _ j�__ No. of compartments------Z_ ______Sizej_ uid depth ------__Capacity__IF4W.___-._ Disposal Field: Distance from nearest well_--47 ___Distance from foundation_ _.__ �t�___.._._.Distance to nearest lot line__�'_�.______ Number of lines______ ___________ ____ ngfh of each line_ __- _i r �� - -- Width of trench-- ----------------------------- Type -------------- --------•-- Type of filter material,� M� epth of filter material___lC� /____:_Total length__ ?'_..__-___ ' ------------ ! >. �{''� le Seepage Pit: Distance to nearest well._./"__•.'_DEstance fr m fouodation___t? ---------Distance to nearest lot line.fQ_ ----._- r rvf Number of pits------/--____-_-__.Lining ma—ferial_:, / .Size: Diameter___ Cesspool: Distance from nearest well_____I-----------Distance from foundation------------_------ Lining materia)-----------------------------------__. ❑ Size: Diameter----- ----------- --- ---- ...........Dept h------------- ------------------- - ----------------Liquid Capacity---------------------------gal . t Privy: Distance from nearest well---_#-------_-------------------------------------Distance from nearest building____-_____-__-_________________.____._. ❑ Distance to nearest lot line-- - --- - -------------------------------------------------------I-------------------- J 6 i - d Remodeling and/or repairing (describe):----� -)exz — �- i -------------- -- = -------------- = -------------- ------------------------------------ ------ dry �J r , i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signed) -- �. - - °'�CO- or) --- : _ n_rac �..� ---- ---- -- - ap BY ------- ------------- � (Title) � �/�= l —---------------- (Plat plan, showing size of lot, location of syste relation to wells, buildings, etc:, can be placed on reverse side). FOR DEPARTMENT USE ONLY ° t APPLICATION ACCEPTED BY !. DATE `�f I REVIEWED BY - - --------- ---------------------------------------- DATE----.- -------------- - --------.--- BUILDING PERMIT ISSUED-------1 - - DATE-- ------ ------- -- Alterations and/or recommendations--------------- -- --p---------------------------------------------------------------- ------•------------------------------------- ----------------- •' F `- ______________________________________________'____ --------------------------------------------- ------------------ ----- ------ FINAL INSPECTION BY:.. .- .... 2ltE ----------- Date--- �' ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave, 300 West Oak Street 124 Sycamore Street r 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California -FIRCC.