19408 - Laserfiche WebLink

Home Browse Search

� FOR OFFICE USE:Te ------------------------------ -- ,-- APPLICATION FOIE SANITATION PERMIT Permit No. ..._,l_ --t'h-�- f_-�5------- -- !---------- (Complete in Duplicate) pate Issued --- -------;J- ---- ------- d� 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 ANDCATION__° I ^__ rdn�?:j_r� l lez-_ r 4 -GAC��7��rf-------•-------------- Owner's Name------------/U ivf�---Ular.t7�h------------------------••------ ---- Phone-_�9` __ 4"z- Address----_--------------_---- 'Address-----------------•--_-•--� ------- -----------------------------------------------------------------------•-----•--------------------------------- Contractor's Name----------------------r�CUh `-------------------------------- -- Phone------------------------------ --- Installation will serve: Residence H-_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/--- Number of bedrooms _ Number of baths j__-_ Lot size ------ O Water Supply: Public system D--Community system ❑ Private ❑ Depth to Water Table _fOft. 4•- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B-74ardpan ❑ Previous Application Made: (If yes,date_- _ __ ---) No M----New Construction: Yes M,<o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well-__ 4_r____Distance from foundation------ p_-------Materia�__ P O _ - j No, of compartments_.--------�---------Size---3iC6`J�C-.-�/--Liquid depth------��-------------Capacify----: �Pl.. Disposal -eld: Distance from nearest well.._:h.e...Distance from foundation---lU...____.Distance to nearest lot line_� --- Number of lines______.___`s'�/______--------__Length of each line_`zV-_`�P-_�Q_-_.Width of french------..-_�__-.___________._.__ ' Type of filter materiallG - �A,_Depth of filter material----- -'`__---.Total length_________________9G_`__-_____-- Seepag it: Distance to nearest well-----._et1�--------Distance from foundation___ ________ _____ �! / 1Q _ Distance to nearest lot line----------------- Number of pits----------- Lining material_X.o_c <____-.Size: Diameter------- ------Depth.....c2S ."_______________ Cesspool: Distance from nearest well-----------------Distance from foundation-----------------rLining material-------------------------------------- 171 Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.--_------___-____-__________--___--____. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------- ----- -- ------------------------------------------------ ----------------------------------------- ------------------------ ---------------------------------------------------------------------------•------•-•----------------------------------------------------•--------------------------- ------•----------------- ----- --------- - -- ------------------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)--------------- -------------------___------ (Owner and/or Contractor) By:----- ---- '+c 6 ------------- - ----------- -------------(Ttle)-------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----- - -------- - - ------ --------------------------------- DATE--- '�-2.� --------------------------- REVIEWED BY------------------------- - --- - ---------- DATE-------- ---- -------------- - BUILDING PERMIT ISSUED------------------- - -------- -- --- ---/--------� -- ------------ DATE --------- -------- Alterations and/or recommendations: ------ �� _____ C1 arr•sr�L- -.- �--- .,c- � - � 'y , /C.TFl� t - ------- - -- --� -------- - ------------------ ---------------------------------------------------------- `lU'rte 6 ------ �`1..�i�' ------ - --- - - --------------------------------- 47 FINAL INSPECTION BY:----- ----- ---� --- Date_----- d--' SAN JOAQUIN LOCAL HEALTH DISTRICT 4 1601 E,Nozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California t F.P,C{]. f