18119 - Laserfiche WebLink

Home Browse Search

SE:-- FOR OFFICE USE- --------------------------------------------------------- - --------- Y __.________________________________-.•_--___--__------- APPLICATION FOR SANITATION PERMIT Permit No. .__.. 1�, .. -------------------------------------- (Complete in Duplicate) _____________________`.-__.___________________'__ Date Issued 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. i This application is made iyr compliance with County O finance N . 5 `sem JOB ADDRESS AN LOCATION------- ,' ��`_:__ ------ ---- - � �- V ---------------lY(- � _ - -- -------------- i�+s3�, Owner's NameX. _ _ ------------------------------ Phonel4__ �3Z7_ f• Address �\ ---- 9 , Contractor's Name QINN •------------•-----R- - -------------- --�--------- - Phone----------------------------------- Installation will serve: Residence [nApa•rtmenf Ho`u e,❑ -Commercial ❑ • Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "�— Number of baths � _pe>Q Number of bedrooms _ Lot size ---___________________ Water Supply: Public system ❑. Community system ❑ Pr�ivaate�❑: Depth to Water Table/7__ ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application"Made:`{If'yes,d'dte_"...!77 .._-_) No New Construction: Yes F�tj�o ❑ FHA/VA: Yes 71' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ---" • �i No-seP tic-tan?k r cesspoolemitted*if ublic-sewer-is available-within-200-feet. Tf =• •�•- =� St e ic : stance m nearest well__1 __Distancfrom.� e , -; T kDif ofoundation=__ / Mater i I_.. Et__W�® ;,-No. of compartments--------��r ---------Size--- Liquid depth.__ �-------Capacity-_A;j2 € p Id: Distance from nearest well-�0---Distance from foundation----112--____-Distance to nearest lot line___________ 0� w^Number of°I-ines """` '"------------Length of each line_ _�'-i__--��:Width of trench___.___ Dis osa ie YP p ---- --- -- rr------�Total length------- _ r ; ------- Type of filter material____ _�-i�K_De Depth of filter m erial_ - Seepage Pit: Distance to near st well._______________...___Distance from foun a ion5�._.`_101 istance to nearest lot line_.- � -"Tll�_�' ❑ Number of Pits_ ______________ _ __Lining materiaY ,I.__ _ .Size: --------------------ia meter- -=---- .---Depth----- -------------------- ------ Cesspool: Distance from nearest well-________________Distance from foundation Lining f material-------_-------------=et-�-- Size: Diameter- ------------------------- -- Depth--- - --- ----------- Li uid Ca acit in-----gals.-.-. Privy: - ______--___Distance..from nearest buildin l WDistance'from'neare"st well ``,-------------------------- --- g----------------------------=-- --------- ❑ t Distance o nearest lot^lin ------------------------------- ------------------------------------------------------------------------�- - ---------- Remodeling. a_nd/c'r' --------- Remodeling. and/or'r pair-n��/.(de,scr�' � -----------T�_t� Cir----- !N T�AX>-----e-F---------36--•-•-------A K'1'4--------I-•'� -----•-= =-------- - -•-------- '�I S-T�M--------�N- -1—C _ ��R Dom_ 11#_TI ��J ,. J =p-- ----" -1� `------Z_F=tg_Cif------ .._:_ .D cV Tk3 A- ' I_!?.,---.. -----I _ f + l�iT�__�( P�1S- --z F-_N_6+[-f- I hereby certify that I have prepared this applicafion and that the work will'be done in accordance with San Joaquin County ordinances, State laws, nd rules andl regulat' s of a an Joaq in Local Health District.. tib! (Signed)____ ' .___{Owner and/or Contractor] --- ------ ---- _- --------- -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed onrreverst: side). . FOR DEPARTMENT USE ONLY APDL€CATION ACCEPTED BY... -Y .......... DATE...... 2__-7.:n vti REVIEWED BY-------------------------------- ------ -------------- - ------ DATE�``�. . -----------•------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE- /------------------------------ ---------•........ Alterations and/or recommendations__________________ _:- - --------- ---------------- ------------------------- -------------------------- 3 _ ----- •------------------------------------------------------- 1 ---------------------------------------------------- ----- -------------- ------------------------------ •------------------------------ ---------------------------------------------- 11 + . - - r FINAL INSPECTION ... _ . .. -r�,� -- -- -- - � Date-------------- - --�----�--�- ----- ------r-------- -- --- -------- S'1=-IE- SAN JOAQUIN LOCAL HEALTH DISTRICT fif30u� 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California. Lodi, California i Manteca,California Tracy,California