18252 - Laserfiche WebLink

Home Browse Search

/2- ---------- - �f'�- - . APPLICATION FOR SANITATION PERMIT Permit No f - - ----- {Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Disfirict fora permit to Date Issued .��•�'-� This application is made in compliance with County Ordinance No. 549. P construct and install the work herein described. JOB ADDRESS AND LOC'ApTION- +� Q ---"- Owner's Name.- � X/ ! -- I Address-------93 '/ ---- ----- ------ - • 4;-1 ------------------------------- --------- Phone -----•---•-•---------•---•�--------- `�. Contractor's Name__ 7�%+� � -------------------- Installation ---- •----- � Installation will serve: Residence ....................... - -------•-- ----- ----- ----- Phone Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: ---J_ Number of bedrooms _�_ _- ❑ Other ❑ Number of baths __j-__- Lot size _- � Water Supply; Public system �n�X/_�ZJ Y Community system ""-"" I Character of soil to a depth of 3 feet: Sand Private [] Depth to Water Table �.$'ft, I ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Previous Application Made: (If yes,date-------- --_. Y ❑ Clay [] Adobe [ f�Hardpan ❑ _. TYPE OF INSTALLATION AND SPECIFICATIONS: } No New Cons+ruction; Yes �' No ❑ FHA/VA: Yes ❑ No4E�- (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: ) p Distance from nearest well___-7r-n------_-Distance from foundation:I"p_` { ®.-- No. of compartments_. Material___.l____:r__--__- _..-.2...............Size x_�__x_.`fi Disposal Field: Distance from nearest well._ Y-_-___Distance from foundation �ept ------Ca acit "`. - p Y--�Oa y-- -. �t Number of lines_'_._�,.,�_-_ - - _Distance to nearest lot line.__u`_�`'-- � -----Length of each line___-7J.._'--- -- Type of filter material__ _0_l---_ --- -------Width of trench__"-_. -Q ' Depth of filter material_-_-�$' ----_--Total length_._._ft5___ o _- Pit: � ---------------- Seepage, . Distance to nearest well-_ - "---- - Distance from foundation__lb_`_ Number of pits-----: Lining material_ p Size: Diameter_--- .- Distance to nearest lot fine. _-__"_"_-""_ Cess Cesspool.- __.Depth.-_- � l' p Distance from nearest well-_-___-__-- _Distance from foundation_-__-_.__-__ __ Lining material___-.__._"_ --_-_ Size: Diameter.--_-:_.----------------- --- -----Depth---------------------------Privy: - Distance from nearest well --- -----------------L'quid Capacity- ---------- gals. -------------------------------------Distance from nearest building ' Distance to nearest lot line _ _ g__..____-_. ___.,_ - 47: --------------------- --------------- --- -- -- Rema ling and/ or repairing (describe):______ - .--- -- .------- -------- -- ----------------------- - - e - - y -------------- ---------------------- I hereby certify that I have prepared this application and that the work will be done in accordanc ordinances, State laws, and rules and regulations of the San Joaquin Local Health District."— t (Signed)_"._.______ � e with San Joaquin Coun ------- ---------- -- J x -------------- ---- -------------------------------------- RY'--------------- �� (Owner and/or Contractor) - { {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. _ FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY R REVIEWED BY---------------- /% - BUILDING PERMIT ISSUED DATE ------ Y _______________________ _______________________________ __ Cera+ions and/or recommendations:__-f �9,�__ �]� �� " DA•TE------------------" " �f " Viral_ _ - �� -G------ - ------------------------------------------- -------- n; - --------------------------- ------------------- ------------------ Y �.y7 r ------------- - c ---------- ------------ •- = , - ---------------------------------------------- ------------- ! ••-----Z11e � R _ . --- FINAL INSPECTION BY - Date ,G. - � -- ------ -- ----- - � - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazepon Ave. � 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California 205 West 9th Street 1-�- �' Manteca,California F,P.Cq• � � Tracy,California 3