19255 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE-- ---'+�J -"_- " Permit No. ._ 1.��. �•`•� --------------------------------- - --- ----__.-li: APPLICATION FOR SANITATION PERMIT f --------------- ----- ------------ I�_ • (Complete in Duplicate) ^—Date'Issuecl --- -- ----•-- -- --------------- --------- - �.-,.x.. --- ---- - -------- _�t This Permit Expires 1 Year From Date Issued x Application is hereby made to: the San Joaquin Local Health District for a permit to construct and install the work herein described. PP a in compliance with County Ordinance No. 549. . This application is ma W��`� JOB ADDRESS A LOCATIONJI_ ,f44---- � ' Owners Name o a --------- Phone--------------------------------- ' -------- _ r i -;------------------------- - --- --------- ---------------- ---- -- ---•---•-------------- Address------- - - - Phone. ' r Contractor's Name--. I -Q-g+ "r - -------- ---- - - - Motel Other❑ i Installation will serve. Residence ❑ Apartment House ❑ Commercial [ Trailer Court ❑ ❑ i " Number of living units) "'!- Number of bedrooms Number of baths -______. Lot size --------- --- - .. , Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Adobe Hardpan ❑ Character of soil to a depth sof 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ ❑ Previous Application Made- (If yes,date_____ ----_---) No ❑ New Construction: Yes ❑ No ElFHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance)from nearest well-----------------Distance from foundation--.-"---"---"-`_.__.Material-------------------------------------------------- No. of compartments Size--------- --------- Liquid depth Capacity Disp❑os Field: Distancellfrom nearest well___.�6-r-- Distance from foundation-__ __________Distance to nearest lot line_________________ Number:lof lines------------ ------- Length of each line-----4-d- ---------;--------Widfih of trench__Z--�-----.--•---------- Type of��filter material--l-M., -�---Depth of filter.material dotal length___:.:__/�Q-------------------- - � Seepage Pit: Distance to nearest well----------------------Distance from foundation____ Distance to nearest lot line__.________.___.. Numberi[of pits----------------------Lining material---------- -----_-----.Size. Diameter Depth ❑ 111 Cesspool: Distance from.nearest wel4_______________ _Distance from foundation_......._..._..____.Lining material__._____._______.__._-_--- -------. De th----------------------- ---- ----------------------Liquid Capacity_-------------------------gals. ❑ Size: Diameter------- ------------------------- p ;11 Privy: Distance from nearest.well--------------------- Distance from nearest building------------------------------ ---------- Privy: Q ' ❑ Distance to nearest lot line--------- -------------------------------� - Remodeling and/or repalrinlg (describe): ------ --------------------------------------- Remodeling ----•-------------- - -------- ------------- ----- - -- -- ------ ----- --- ---- N ------- A �- .,x.-a.3 K .r --- ---- ;,�. I herebycertifythat Ilhave prepared this application and,fhat.the work will be_done in accordance with San Joaquin County ordinances, State,laws„and..ruiesb andiegulation frthe•San Joaquin Local Health- istrict.' N ) an r Con---------------------- tractor) d/o ' ------------------ ----- ----------. ___________ ---------------- (Signed) u -(Tit) ---------- --------- ----- - --------- By: ---i ----- ------- - lot Ian, showing size of lot, location of system in re ation to wells, buildings, etc., can be placed on reverse side). (p p , s .i - ii. FOR DEPARTMENT USE ONLY f "�„"Rr ' ar --- DATE------ APPLICATION ACCEPTED BY - ----------- ------------------ - DATE REVIEWED BY---------------------!------ - --------------------------------------- - BUILDING PERMIT ISSUED-------•=------------------------------ -- ------ ------ ----- -------------- DATE---------------------------------------- ------------ ._ ' ._- ----------------------------------------- --- i, ------------------'------------------------------'---------•------•-------- ---------------------- } Alterations and/or recom�en a ions------------------- - � �,,;_,.� -mus � � -----------------•--------- ---- ”-- --------- -----------"-.. ------------------------------ 'I ---- 11. y E n� _- - �� I� _ Date--- ------------------------ ---------- ------------ FINAL -- ----- ---------------------- -------------- FINAL INSPECTION BY:----/--- A__ JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street ;tockton,California Trac / �l Lodi,California Manteca,California y, California ES 9 REVISED 8.59 3M 3•'6'3 F.P.CG. • /