20917 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE,y��`�� , a �f� \ APPLICATION FOR-SANITATION PERMIT Permit No. - ---------------------------------------------------- -- (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. This application is made in compliance with County Ordinance No. 549. ti JOBADDRESS AND LOCAT N__ _�`--1/'- .------� �- '---------------------------------------------------------------•----------- Owner's Name--- - _ ------------- -------------------- Phone------------------------------------ Address. `... -----------------------------------------••---------------------•---•--•----------------------------------------------------------------- Contractor's Name___^ Phone___________________________________ Installation will serve: -Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ oeP Number of living units: _!7:-Number of bedrooms _----_ Number of baths _0Z__ Lot size _ ��- C.s �l��-------------------------- Water Supply: Public system El Community system El Private Private Zo1<epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--nardpan ❑ Previous Application Made: (If yes,date--- ----------------) No ®!'New Construction: Yes 52-I'llo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Ql (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V Sep�ticf Tia s Distance from nearest well_______ _______Distance from foundation-------------------Material------------------------------------------------- No. of compartments-- -----------------+� Size Liquid depth Capacity f �� Diyosal Fielj: Distance from nearest well.-.- if9.__..D1stance from foundatio ___. �_ ____.Distance to nearest lot line__. .-.-- Number of lines__ __ _� __.._- ength of each line_____ ----- Width of trench___________________________-- le --- ---/ L Vj- Type of filter materia � epth of filter material-----� ---Total length 9Q l 7 ,,A0-__._-_.Distance to nearest lot line---le__---- Seepage Pit: Distance to nearest well-_�._��-- -Distance fr fou dation__ - � ! ` , i� Dept'a P"------ ®/ Number of pits_____ _______________;Lining material-_ _ _C�_._.._-Size: Diameter .__ ��'�"- Cesspool: Distance from nearest well-----------_-----Distance from foundation..... _.-----------Lining material-------------------.____.________-___. ❑ Size: Diameter----- --------------------- - --------Depth----------------------------- -- ------------------liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------_-----------------Distance from nearest building-----.----------------------------------_. ❑ Distance to nearest lot line------ ------------- ------------------------- --------------------------- ------- ------------------ ----------------- ---------- ---- Remodeling and/or repairing (describe)___________________ _• - ------------- - j -------------------- ------- --- --- -------------------------------------------------------------- . � --__ _ - ----- ! herfte I haveprepared this application an hat the work will ISe done in ac�ance ith an oa-/ Count ordinances, State laws, and rules and regulationsof t e San Joaquin Local Health District, k S e" rYb 1 ------------------------------------(Owner and/or Cont r c or) (Signed)------------------ - s [Title) v` �� By..... ----- .------------ - -- _- - (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY �y APPLICATIONACCEPTED BY------------- ---- -------------------------------------------------------- DATE--------d---77/7 V115--------------------------- -- REVIEWEDBY... -- --- -- - ------ ----------------------------------------------------------------- DATE.---- ------------------------------------------------------ BUILDING PERMIT ISSUED--------- -- - ----- ------- - ---- -- DATE------------------------------------------------ Alt afions and or recommend ions:__. r-�1_!!k�------ u ------------ -- - ------ ---------- ---- 3' u rudollP �--- ----- y �rl~G� T�` /eJ/ p f r �j�i# ala -- ---- ►�a�L -------- -- -- -- -- -- -- --- /�/// �i �J -- ----- -- R ,Fye d�/,�f - �.--`id7 �---'�----Y r vNe_.'-_ - '�y`'--�-'--� ----_ ._ -'-- - - '- -�t- f --------`.rn _ ._ _-y---"/""'_ .. � f ..... -a kilt r{J['y L4ir f �Q �f. f�x/it/�'U v{-----a ° 3't G FINAL INSPECTION BY:......._ .. . ---- - ---------------- Date--...... ----------- ------------------------------------- L - SA ,IC- QUIN LOCAL HEALTH DISTRICT / 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California