19723 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: / ,a ---------------------- �- / � ------------- // -------- ------------------------------------ ------- ` APPLICATION FOR,SANITATION PERMIT Permit Nol_ (Complete It1� Duplicate) Date Issued/ a �P-�•�� _-.--____----------------------- ------------------- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND ..LOCATION------ -�.O------�'-1�-- �-"------------ - -------------------------------------- -- ----------- Owner's Name---- l$d' -^ - - Phone Address-------- --------- -------- ..... ------------------------• --------------I——-------------------------------- Contractor's Name---x----__--- Phone '?,_... '4 Installation will serve: Residence Apartment House ❑ Commercial I] Trailer Court ❑ Motel ❑ Other E]Number of living units: _ -- Number of bedrooms-- Number of'�l?a�ths 49_-. Lot size 140-/ -�- Water Supply: Public system El Community system'[] Private [ epth to Wafer Table 4616-ft. � s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'❑ Clays❑ Adobe `Hardpan ❑ 1 qt, Previous Application Made: (If yes,date------------- -.__-f No WR**' New Construction: Yes ''[ No E] FHA/VA: Yes �"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o - dation_.f�.-----,:.Maf$rial_L.:�_��-- !'-r Septic Tank: Dot of compartments--ance from neeesf weh v�--- ----Siize��p��---Liquid depth-X-��----------.Capacity-� ---______�____ � Disposal Field: Distance from neares well-._40------Distance from fo�`dafion_,��. _. _Distance to nearest loft line.-_______ ®� Number of lines____ ________.. Len th of each line_- s _-- -.Width of,trench.__ _._._- g l -------------------- Type of filter materialA�� Depth of filter material__ ___ ___Total length_./=f_0__-------------------01 ; Z-10------- �} Seepage Pit: Distance to nearest well__14-a-_____Distance fr m fo ndation___________ __ 22,0p'a to nearest lot lit e_ �r Number of pits....4-------------Lining material_ � .Size: Diameter:_�.�____------Dept h_:ri7s> '---- Cesspool: Distance from nearest well-----------------Distance from, foundtion _'�`__., . :-Lining material________ ______ --__-______________- ❑ gals. Size: Diameter Depth f., , , , = ------ Privy: Distance from nearest well----___------------------------____....----------ECtarCe' from nearest building---------------------------------- --------------Distance to nearest lot line------- ---------------------- t,7 ---------------- -- a y Remodeling and/or repairing (describe):----------4.70 --- ------------------•------ - - ------------ -----------------------------------------•• --------------------------- r.. ---------------------------------------------------------------------------------------------------- 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. 5i ned ------ �or Contractor] r --------- By� "._ ",." .-(Title}_ (Plot plan, showing size of. lot, location of system in vela n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------------------------------------------------------- DATE /�__ e2(-= f�. REVIEWED BY-- ------------------ ------------------ - -------------- ------------ --- ---- ------------• ----------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------- •------- ------ -------�r-G�--'-_---9--z�- . ' - DATE----------------------------------------------------•------- Alterations and/or recommendations--- ------------------- ------------------------ ----------------------•--- --------------------------��---------------------------------•------------- 4----- ------------------------------•-------- � ---------------- -------------------• --------------------------------------- ---------------------------------------- t FINAL INSPECTION BY: /--- Date_ 1p 'z�'G'-J---- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT , -� 1401 E.Haxelton Ave. 300 West Oak Street r, 'l t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California a Manteca,California Tracy,California F,RCO.