68-317 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USES --------------------------- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. .� ____J�_l -7 ------------------------------------------------ (Complete-in Duplicate) Date Issued - -- ............. ........................---------------- This Permit Expires 1'Year From Date Issued � 6� 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 No. 549. JOB ADDRESS AND LOCATION-p �7?09�------I - .._ o a f ' �/ � ------------------------------- Owner's Name---------- - --� .-.-------- ��__ ��`--�---- - ---- --- -- --------- - ---------------- -------- Pone------------------------------------ Address ---------------- ----------------- Address---------- 5, W-2- == -- --- Contractor's Name------ 1MV-- Phone Installation will serve: Residence ®-`Apartment House ❑ Commercial �❑ Trailer Court ❑ Motel ❑ Other ❑ ; Number of living units: _/-_- Number of bedrooms-- Number of bafhs.,A`..__ Lot size aeol* --`-------•--------------- Water Supply: Public system ❑ Community system [] Private R?'6epth to Water Table 41 ft Character of sail to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: [If yes,date_------------------ ) No W5#11 New Construction: Yes R�No ❑ FHA/VA: Yes P— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ye;er is available within 200 feet.) Septic Tank: Distance from nearest well__ .--_-.D,istance from foundat-on.-/a__-._-___.Matyi�� .¢ - __.-_____.___. No. of corn pa depth__- .- Si, .P' ..Capacit�,90L� - x p f ---�, �`-� , Ir Disposal Field: Distance from nearest well-.4"e-----Distance from foundation__-oo'.a.-._-.--Distance to nearest lot line-_ _--.----- Number of lines.___._.__ ___.._ ength of each line _go- -/.-.--yWidth of trench-,,!Z------------------------------ Type of filter material/� � Depth of filter material.--/ ....-.----Total length ------------------- Seepage Pit: Disfance'to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----__----_---.-_ ❑ Number of pits--- --------------_-Lining material------------------- _ Size: Diameter.-.---..----------._._.Depth------------------------ --- ---- E Ar13,e1: Distance=frl- om nearest weld ----------------Distance from foundation.....-----.-_-_._ ..Lining materia __.--_-_______--.-._-__,__--_---- l` Size: Diameter- -- --- ---------- --- -----------Depth------ - - ---------------------- -----------Liquid Capacity--------------- ------------gals. I Privy: Distance from nearest well-------------------------- --------------------_Distance from nearest.building.----------------------------------------. Distanceto nearest lot line - ------------- --- ------------ --- - ----------------------------------------------------------- ------------------------------•---- Remodeling and/or repairing (describe}:_... «�� d 1�----- ------ .- ------ --------------------------------------------------- -----•-------------------------------------------------- •--•---------------- -------- ------------ ----------------------- ------------------- ----- ------------------------------- ---- I - - ---- --- ------------------------------------------;--------------------------- ----------------------------------------------- ------------- ------------•----------------------------------- ! I hereby certify that I have prepared this applicafion and thafrthe 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)------------ - - -------------------------------------------- --- ---- --------( 'or Contractor]. B t --------(Title)-404�- ----------------- (Plot plan, showing size of lot, loc n of system in relation to wells, buildings, etc., can be laced on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- ------ DATI -- - - REVIEWEDBY----------------- -----= - -------------- - .__----- - ---- - - ---------------- --- -------------- -- DATE------------------------------- ----------------------- ---- BUILDINGPERMIT ISSUED-------- -- - --------------------------------------------------------------------------------------- DATE---- - ---------------- --------------------------------- Alterationsand/or recommendations---------------- - ---- - - ----------------------- ------------- ----------------------------------------.-...-------------------- --------- ----------- ---------- - ----- ----------- ------------- - ---- -------------- ----------------------------- ------------------------------- ----------- -- - -------------------- ------- ------------- . FINAL INSPECTION BY:------40R --4,-_ f,, / /t1l Date------- =Z2---�- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street ` 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California i Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press