19894 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ------------------------------ -- ---- Q _II---- APPLICATION FOR SANITATION PERMIT Permit No. L -- ---=---------- ----- -- (Complete in �uplicate) — .._. Date Issued �a_,,7 .5 _________________________________�_- This Permit Expires 1 Year From Date Issued zn � raj©ria6 Application is hereby made to the San Joaquin Local Health District for a permit to construct and insial[ the work herein described. This application is made In compliance with Coun Ordinance No. 549. JOB ADDRESS AND LOCATION u ' ?'thllc - ----- --- �� - Phone ti------•--- Owner's Name_- --------------___l�Il --------�.- - - - j --- ------------------------------- -- ��YJ Address 1 � r t '! -- --------------------- Contractor's Name------._..._ --ff �! ---- --- Phone----------------------------------- I Installation will serve: Resi d!ente ❑ Apartment House ❑ Commercial ❑ r Trailer Court Motel ❑ Other E] Number of living units: :":-�___ Number of bedrooms ___��Number of baths __.1___ Lot size :-_ -i --- ---------- Ilh Water Supply: Public system ❑ Community system ❑ Private Depth to"Water Table �Q. ft. Character of soil to a dept k of 3 feet: , Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe Hardpan ❑ _ r Previous Application Madej" Ilf yes,date__=='---. __-=-cl' Noy New Construction:-Yes No [3—FHA/VA: Yes F] Nolt4 r TYPE OF INSTALLATION �r4ND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet) Septic Tank: Distance from nearest well-.-�_D_0.__Distance fr m foundation _�_..._-Material _-_1� - q� �I �` -/ No. of compartments------- r� ---Size-' 3r X_ Liquid d Ifh---- --- f ----- Capacity- --------- Disposal Field: Distance from nearest well-----�<_o _Dist n �e fro fo�}�ndp.�j iQp______6--_________.Distance to nearest lot li.e_� Numberl'of lines________ w--__Len M o:KKOCR line--/.--------__ Width of french----- 4 ._��------------- Type o'filter material-_,___` Depth of filter materlaL____�_ ___,-_*-----Total.length___._____ ___f ___________________ Seepage Pit: Distance to nearest,well-____________________Distance from foundation-------------------.Distance to nearest lot line____-- ..______ -------------Lining material--------__----.-----...Size: Diameter----------------------Depth--------_------------------------ ❑ Number of pits---- Cesspool: Distance from`nearest well-----------------Distance from foundation-------------------.Lining material__.__________-___._______________. �It Y ❑ Size: Diameter-at ---------- ----------------- Depth------ - -------------------------------------- ------------ -- ------- - Liquid Capacity------------- - gals. Privy: 5-:=a t' from nearest well -`'r'"._ ____:_'------_.___ _ __ S ante from nearest building__________________ _ _____ _---------- i. ❑" Distant to nearest lot line- -------------------------------- ---- t'"------------"-- -------------- Remo a ing and/or repairing (describe,:_____ __ ' )��"-"" --------------- -------- ---- -- ----- -._.:__`._.�I__�_•,__-�•• ,__ ------------ ------------ •- - ----- ----- ------------------- ---------- ------- -- = I hereby certify that Ilihave 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)-_,y.- ' = _q±i a6 ----� __, = = ------ - ------- - ------- ._..(Owner-and/or Contractor�_w. BY: I------------------------- ---------------------------------------------------------------------------(Title)------ -- ----------------------------- - -- (Plot plan, showing size of to t, location of system in relation to wells, buildings, etc., can be placed on reverse side). ll� FOR DEPARTMENT USE ONLY ---APPLICATION ACCC EPTED REVIEWED BY. -• --- - BY---- --•----- ------------------------------------ -------------------------------------- DATE------------------------------------------ ----------------- VIII __ DATE ; L '"f `�' BUILDING PERMIT ISSUED--------------------- -------------------------------------- - = QATE Alterations and/or recomn en ations------------------------- - ---------- - -------- r----------------------- •� - _7% 1 .�e Y- �,� �' -.0 � ,_v .------------------------- --------------------- -- ------- 6-11----- ------------------------------ ------------- ------------- ------------------------------------------------------ I _ FINAL INSPECTION BY: ` ..- bate J i ----- �-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave: 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California!j Lodi,California Manteca,California '!racy,California Es 9 REVISED B-S9 3M 3-163 F.P.ra.