57951 - Laserfiche WebLink

Home Browse Search

TM Permit No. - `�,,1`' APPLICATION FOR SANITATION,IPERMIT� 11 (Complete in Duplicate) Date lssued��__�_,�___ _ 777 Applicaaion is hereby made to fiheasan Kaquin'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___________________"--_-.--___ 39!VV Owner's Name --------P - —----- _ :� Phone -------------------- -------- �. _ ------------------------------- Address.------- ------ --------- ------ .,�—?/I/ - _ . ` !T - --------------- Phone ----•---------------------- Contractor's Name------------•---...--•- -- `-��_�-----------�`'-``c.c..�-•------------------------------------ Motel Installation will serve 'Residence`-Apartment HouseE❑ ,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 / ---1.-�--�--------�'-�•-------------- Number of living uni}s: _1--- Number of bedrooms ___.__ Number!of baths ____---- Lot ._ Y Y 'jDepth to Water Tabls; rf+- Water"Supply: 'Public system ❑ Communif � stem..❑.—Priva,tie„ i fe . . _ Character of soil to a dept{i of 3 feet: Sand ❑ Gravel ❑ Sandy Loaml❑ Clay Loam ❑ Clay ❑ Adobe 'Hardpan ❑ Previous Application Made: Yes ElNo [ ew-Construction: Yes ❑ No 0—" t TYPE SOF INSTALLATION AND SPECIFICATIONS: ,' ; i r ` No septic tank or cesspool permitted if public sewer is available within 200 feet.) x . epti I Tank- r Distance from nearest well�----- Distance,from-foundation-------------------- __________.---------------------------.__-__. No* of compartments - Size-.-------------------------_-- Liquid depth = Capacity p i Disposal 'Fi Id: Distance from nearest well._�--------Distance from foundation_.-�-�--------Distance to nearest lot line_________________ Number-of lines------- ------ -- Length of each}'line___3'0-----.----------.Width,of,#Tench------'-�-`�---,l-------------- ------ Type of filter material_S�-/ -----Depth of filter material___._1_ Total length-------- -----------------" " V T _w_Distance from foundation_ ----- Seepage � ___.Distance to nearest lot line_'S___---- Seepage Pit: Distance to nearest well g � Diameter. i � +' ------------------- Number tfoundation.- Lining material ---------- i , p / _ -_ a+erial;S__. 1 � ---Size: Diamefier-__..""k -----------De to------ -------- Cess ool: Distance from nearest well_______________ Distance f [,umber of its:____-_�_ __ __ " " inin m P_ � a .. � �__�_° Li uid• Capacity --------------------------gals. ❑' Size: Diameter----------------- ---------�---'---�epth- _-^----------- -,---------- ----------. - t q , Priv Distance-from nearst vrell______,------------------------------------------------ __Distance from nearest building___-____.-_-.---------------------------- T ❑ .. ..�_•..,� ---------- Distance to nearest lot line' - ---------- --- --- -------------------------------------------------- 1,�Ii ' :.`t" .-_ .-------------------- Remodeling and/or repairing (describeJ:____.__..__-___.___ i - -------•------- ------------•------- _____________________________________________"_________"__.______....___._..____..___.__._____._____..____._____._ [[------____..._____________________ ______.____.__ 1 _ ____.___"____________________________________________________________ _________________ _________________________________ fy that I have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certi ordinances, State laws;'and rules and regulations of the San Joaquin Local Health Distric -� [Ow r and/or Contractor) , - = -------- , --- --------_------------------------ 5igned). .._ . �y- i -----------------------k �.(Title)---. -- ----- -- --------------- ------------------- By:--------------------- ----• - -------------.- [Plo# plan, showing size-of lot, location of syst m in relation to wells, buildings, etc.,•can.be,placed on reverse side). f r FOR DEPARTMENT USE ONLY APPLI �, - ------------ DATE---------- ACCEPTED,BY-___._____- -3 DATE.------------ REVIEWEDBY-------------------------------- ----------- --- _ ' BUILDING PERMIT ISSUED - ---------------- DATE Alterations and/or recommendations:___.'--------------- ------------ -- ---••---• -r . F --- - -- ---•---- ---••----------- ---------------- ------ --------------- - f --------- F ------------------------------------------------------. ----------------------- f Date=---- --=---=-"------------ -s�� " :•---------------------- FINAL-INSPECTION .BY:-__ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. Y • ES-9--2M : Revised W-2100 _