21494 - Laserfiche WebLink

Home Browse Search

FOR ?OFFICE USE: - /` APPLICATION FOR SANITATION PERMIT Permit No.4-2 1 _l�_ --- iq (Complete in Duplicate) -------------------- This Permit Expires ] Year From Date Issued Date Issued _-'h_ � 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 OrdlriWte No. 549 JOB ADDRESS A LQCAT ON__. Q_r -. `-------------•- ------- ------ Owner's Owner's Name------ -------- b�Z3&r Phone ---- Address------------------ Z� Contractor's Name_- -- -- ------- -- -- ----- ",�""T -- 'r t ----.._. Phone ---...-- - / Installation will serve: ResidenceUApartment House ❑ C mmercia ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -ii_----- Number of bedrooms- Number of baths I---- Lot size _7S=5--- --------- ' Water Supply: Public system 9000'Community system ❑ Private ❑ Depth to Water Table,6:0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ r Previous Application Made: [If yes,date...............:.._} No ❑ New Construction: Yes ❑ NoFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti N Distance from nearest well_________________Distance from foundation--------------------Material___----------------___.._-------------------------------------------------- No. of of compartments------------------ ------Size-------------------------------Liquidd depth--------------------------Capacity-------� --` osed ' d:(QJ 'Distance from neare+II.L--_0isfance from foundation__,159._Q -_.Distance to nearest of in�______________-- umber of lines-___ _ Length of each lin ___-- ___ __ Width of trench____ _-- __ ____ (�j Type of filter maferip T. gDe th of filter ma erlal__ ______ Total len th_____________-__ - _Q______-_iSee a e Pit: Distance to nearer, Dista from foundation___. ____ Distance to nearest of line__.-Number of pits----- -- ateria l ----...Size: Diameter__--- _ -- Depth_-------------__- Cesspool: Distance from nearest well-----------_------Distance from foundation-------------------.Lining material__"-------------------______________. - ❑ Size: Diameter--------------------------------------De,pth---------------------------------- -----------------Liquid Capacity_------------------------..gals. Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building------------- ---_-._____.______..____._. ❑ Distance to nearest lot line------- ---------------- ------------------------------------------------------------•------------------------------------------------------- t Remodeling and/or repairing (describe)__________ __ ____ _____ ____ ------------------------------•------------------------------- --------- - --------- -- -------------------------------------------------------••-------------------------------------- - ----------------- ----------- - . ----------------------I-------------- ------------ -- --------------------------------------•--------------------------- ------------------- --------------------------- ------------------------------------------------- it f I hereby certify that I ha a prepared this application nd that t e wo k will done in accordance with San Joaquin County ordinances, St f s, a ules reapplication of th an Joaqui oca He District. (Signe .... -- -- --- --- - -- --- - - ----- - --- -'---- ---- ---- -------- Contractor) Plot Ian, showing size of lot, location of system in rel n o w s` buildings, can bele laced on reverse side). Y:----- ------------- (Title) ( P 9 y g , p e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---------------------------------------------------------------------------------- DATE �' - 4 ---------------- REVIEWEDBY-------------------" --------------------------- ---------------------------------------------- DATE------------------------------ ----------------------------- BUILDING PERMIT ISSUED------- ----------- ---------------------------------- --------------------------------------------: DATE------------------------------------------------------------- - Arans and/or r commendations_ _____________ _________ __ TO _ ----------------------------------------- --------------•---------------------•-------------------- ------,------- 1,5� �.r . _- .e. �--- --------------------- ------------------------------------------- ------------------------------------------------------------------------------- ------ ------------------------------------------------------ -- -------------------------- -----• -- --------------------=-----------------------•--------"--- ---------------------------------------- --------------------------------------------------------------- --------------------------------------------- --------------------------------- - ---- --------------------------------------------- ------ --- - r � FINAL INSPECTION BY:----...... r ---------------------------------------- SAN --------------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT j 1601 E-Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0❑.