22507 - Laserfiche WebLink

Home Browse Search

rUK UJI-N : USk: � .= 7-G7------------- --------=-- ------------ ---------- = __ ------ APPLICATION FOR SANITATION PERMIT Permit No. 19LS2�,? ------------- ------------ -------------------...-------- (Complete-in Duplicate) - -------------- ------------ -- This Permit Ex ires 1 Year From !Date Issued Dafd--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 o. S49. JOB ADDRESS AN LOCATION__-- _ _.r-- ---- , P------- Owner's Name a � �•C' ''�. Phone_�� �-------------------------- -- --- - --- - (� �y� . f -- ••5 Address � 1,� S_.`L--------Ar•-L--- -------------------------------------- Contractor's Name----------- ----�--�- -1°IL�.'.:e_.-----• ---------- ----- ------ -------•--------------- Phone------ ---------•--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __ ----- Number of bedrooms ' Number of baths__. _ Lot size ------ , .--__ � C]-• .R............. ___ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan'❑ Previous Application Made: (If yes,date___-._---_ --.._.. 1 No ❑ New Construction: Yes Vr No TYPE OF INSTALLATION AND SPECIFICATIONS: El FHA/VA: Yes (] No E] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_,&j!Aa^ jisfanc from foundation_____ __ r u Mater I _ G------i:. No. of compartments Size_ -, ' '- - ; squid depth_..._IV -.�_...Capacity �L�1 Disposal Field: Distance from nearest well.6�/ey ;stance from founds+ion.___.--_____.___...Distance to nearest lot linef______ I Number of lines _�--------- ----------- -------Length of each line__---_____- v - �------�;�---.Width of french------- -�---- --------------- Type of filter materiai__._ -*-1K-___-Depth of filter material_.-I_. --___-----.Total length_...-__.__ 11_zt__-_ Seepage Pit: Distance to nearest well __ _____________Distance from foundation _ ________________.Distance to nearest lot line-------------- p ❑ Number of pits.-- --------- --------Lining material-------------- ------- Size: Diameter-- -------------- ----Depth--------------------------- .._--- Cesspool: Distance from nearest well ._-___.__..___-Distance from foundation._-.__.__------- Lining material \ ❑ Size: Diameter- ----- - ----- --- ............Dept h- ------------ ------------------ --------- ------------------ Privy: Distance from nearest well -- ---- - --- -Li9 Liquid Capacity.-.-------- - ----galsV , F1 _ _____________ - ---_ . Distance from nearest buiidin g Distance to nearest lot line........ Remodeling and/or repairing (describe):._.__ . _.--- r ------------ ------ r•-r�-- �H -- /1 � ------------------------- reti -- ----•--------------------•---------------------------------------------------------------------------------- ! 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 f San Joaquin Local Health District. � (Signed)---- , I -(Owner and/or Contractor) Plot len, showing size of lot, locatio,t Title Y ------------ P 9 n of system in relation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT OONLY APPLICATION ACCEPTED ------------ EVIEWED BY. - -------- -------------------- ------------ DATE---------------- ------ BUILDING PERMIT ISSUEp ._.-._ _ "��----- - ------------------------------------------ ------------------- ----- and/or recommendation ------------------ -------- A'TE----------------------- - --- --------------- ---------- --------- ------------ ----------- ------W-------- - --------------------- ------------------------------------------------------- ------------------- - ------- ------------------ --------__ FINAL INSPECTION BY:..---- -- f.�- ------- ---------- ------------- Date.. ------- f'Z 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 724 Sycamore Street � 205 West 9th Street Stockton,California Lodi. California Manteca, California E.t1.92M T•67 Vanguard Press Tracy,California