20038 - Laserfiche WebLink

Home Browse Search

FOR,OFFICE USE: ------------------------------ ---------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. .. - ----------------------------------- ------ (Complete in Duplicate) Date Issued /77 - �-�� --------_---____-------------_---------------------------- 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.'----------�T-------- --------Lovj_s�--------------------------------------/i'l q.T ------------ i Owner's Name------------------ -E--rq-!-------- -----E--R-ER-------------------------------------------------------- ---------------- Phone------------------------------------ Address................3QV---------- {,-------- _ 1�-� =------------------------------------------------------------------------------. .-.-------------------------------------- Contractor's Name —- -L>(=-------------------------------------& ------------------------------------------------------' Phone --------- It Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: ___1__.)Number of bedrooms __2—Amber of baths __ Lot size ___ _________________________ Water Supply: Public system ❑ 1Community system 0/'Private ❑ Depth to Water Table -!j(-- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam J Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_._,_._-_.,_____._) NopNew Construction: Yes ❑ No �HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or.cesspool pyermmiitteed if pybric sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distanccefrfroom foundation_------------------Material_______________________ _...___-_____. 15- r, No. of compartments---- ------ ---------Size-----.--------- -, --------Liquid depth- --------------------Capacity...--. ---------------- Disposal ----- -Disposal Field: Distance from nearest well....�-O____-Distance from foundation___Z0--------.Distance to nearest lot lin --S___.____. T1�,{C,— Number of IineF_____________01..._.__.._______Length of each line_-________--_____ Width of trench-------- F xt �1Dp, Type of filter �aterial---RQ_CK-----Depth of filter material_____0147________-__Total length__________,&Q_______________________ Seepage Pit: Distance to nearest well_______________ Distance from foundation-------------------Distance to nearest lot line----------------- El Number of pits______ Lining material.......................Size: Diameter-----------------------Depth____-___.______.______.______-- Cesspool: Distance from nearest weld------------------Distance from foundation--------------------Lining material-----------:______________.________ ❑ Size: Diameter---------------------------:----------Depth--------------------- ----------------------------Liquid Capacity------•--a-----------------gals. Privy: Distance fromnearest well-------------------------------------------------Distance from nearest buifding-_---.-__---_-.~_____ ❑ Distance to nearest lot lire-------------------------------------------- __ 1% ; #4 -AX 1% : 4 V Remodeling and/or'repairing (describe): ----------------- ------------------------ --------------- -- •»,. ------------------------..------------------------- '_., '1.7 _a 'I _fps . ..°k�IL4 ..---ZEE-----A�,i l Ly4_L-�_ �------------ 11s-_-------------= 'fl-`------- ------------------ ---- ------------------------------------------------ I hereby certify that I have`p_ pa ed'this applicetion and`that_fhe'work will he done in-accordance with San Joaquin County ordinances, State laws, and rules a regulations of the an Joaquin Local Health District. Ij , ----------- (Signed) ~ Owner and/or Contractor - i �f --------------------------------' ( / 1 _ _BY=-----------------*----•-------------- ------... - (Title) Plot lao;showin f,siie of lof,16o a 6ri of s`sterrt in gelation to wells buifdin s etc.,'an be laced on reverse side sf_ FOR DEPARTMENT USE ONLY I � APPLICATION'ACCEPTED BY---------r—LB-0.--------------------- ------ ---------------------------------------- DATE-------- IJ�' �.Q-.(�--------------------- REVIEWEDBY------------------------------------------------------------------------------------ -------------------------- DATE-----•-------------------------'----------------------------- BUILDINGPERMIT ISSUED------------------- ------------------------------------------- " ` -`^; --------------- DATE---------------------------------------------- -------------- Alterations and/or recommendations:-_ a. .___ �_ - -----------------------_ _ , . ------------------ ' -----'--------- =;- -------------------- --------•-------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ t iFINAL INSPE -- -��- ----- -------- Date------------ -A/7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave, t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California ' F.P.CO.