22096 - Laserfiche WebLink

Home Browse Search

rOKOFFICE USE: `_.___. _ APPLICATION FOR SANITATION PERMIT Permit Nol.909S:?••_ - -' -------- --------- (Complete-in Duplicate) .. ._ti_- _, IDate issued?-.2 y- t4,7 --- -- ---------------I --------------- --- _--------- I 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. +s application is made in complia10* nce with County Ordinance No. 549. I I JOB ADDRESS AND LOCATION.__ ----------Vj_4h / �+ q, / ' Owner's Name' L1.� VV. �- _Q _ 44 i Address . # ' - ------ t -Cotactor's Name _ _ one Installation will serve: Residence ❑ Apartment House ❑ Commercial 5( Trailer Court ❑ Motel ❑ Other [❑ Number of living units: __ -- Number of bedrooms __"____,Number of baths -------- Lot size Water Supply: Public system Community system'E] ` Private ❑ Depth to-Water Table 7 7t Character of soil to a depth of .feet• Sand,❑; Gravel ❑ Sand Loam Clay Loam 1 Y . � ❑ y ❑ Cay ❑ Adobe Hardpan Ej Previous Application Made: (If yesdpte_. .. ._.:< .. ] No'V �New'Construction: Yes M No FHA/VA: Yes ❑ No,'� TYPE OF INSTALLATION-AND-SPECIFICATIONS: -- � � - v-- - 4 i �, .w (No septic tank or cesspool permitted iii public sewer is available within 240 feet.) Septic Tank:a 0110" Distance from n�ere5t ' ell_:-.____"-------_Distance from foundation-------4--------.---Material.-.:____________ _________ ❑ No. of cornpartrrients ---------------Size-=--------- - '= . °Liquid :depth--------- ----- Capacity a Disposal Field: Distance from nearest well ..... :Distance foundation....... to nearest lot line__________.._____ S � 5 i L , S . ❑ °` Number of lines; ----------------- -------------Length of each line-- f------------Width of trench -------- T e of filter material___."_______--------__Depth of finer material-__-._„ -------a._Total length_."..__._-____-.__"-"_____--_.___----.___ Yp_ l RR .�. } Seepage Pit: Distance to nearest well fVl� Disfance from foundafion___ _e_.._.Di.fan e to nearest I line-_. ".- Number of its-__00 ` ao p -.____-_-J Lining material__ �.- Size: Diameter_-- .-___._.._Depth_._ .. __�_" o �.a - T' Cess ool: Dis'fance'f,•om nnearest wellt�'•t p � � _....._-._-Distance from foundation."--------------- --Lining material..------ ""-----------". ❑ Size: Diameter. ._.___ _ —K Depth Liquid Capacity ----- --------gals. Privy: Distance from nearest well._._______. ..___ _. ._ -_- ------Distance from nearest building "rN -c e ,, is k ti. * line V:------- ' rt Remodeling and/or res a+ren odescr be t -_-- , ..-- _ _ / p 9 f I 1 _ - -., -- ----------------•--- " .� A. ____________________ __ ________ ti -______-___"-__.-_-_-.....____-_.._____-._______-__-"___-_______--._.__-__. .___---.__-___"_______________ _ . e -.� _____________ ____k._ __._.__.___-_..______._____ _____. __-_ ----------------------------------------------- x *w his�a " I''rcation ------ ---------------- I hereby certify that I have prepared Yt r pp ' and that the work will be done in accordance with San Joaquin County ordinances, State la d-rules and regulations of the'San Joaquin Local Health District. 4 �.t r (Signed) --------------- -£ x I # r - --- -- ---1= ..-----(Owner and/or Contractor] Plot Ian, show' size of lot, location of syst n rel tion tows, buildin --- -- [Title]_.___. . .-,; 4--------- ---- ------- ------ B - - ( p 9 gs, etc., can be place I on reverse side]. P i FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY__ _ -------- ---- ----- -------------- DYATE_ -'--�--~-- -- 7- --------- ----------- I REVIEWED BY------- - DATE BUILD -- -------------------- IN PERMIT ISSUED ----------------- DATE------------------------------------------------------------ ------------------ Alterations and/or recommendations____--------_---_".--"--.-". f-1----- ------------------ -----------_______________ _ E ........................................................_ r ---------------- -----------------------------------------..-_.____..-_..__.. __-_...__.....__ ------------..._....._---..------'........... n FINAL INSPECTION BY:. - ----- . . -- ------ Date .'. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 9 Stockton,California Lodi, California Manteca, California Tracy,California E.H.9 2M 1.67 Vanguard Press r