17721 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; ----- -- ---------------------------------I-------------------- ---- APPLIqATION FOR SANITATION PERMIT' Permit No. _.�_��._2./ - ---------- ----------------------------------------- - - - - (Complete in Duplicate) y ------ ---- ---- ------------------------ ---- -------- - This Permit Expires I Year From Date Issued Date Issued -- Application is hereby made fo'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 LO m C) V _UAI ION----------- -- -- ---- -- --- ----- :7=7��-Phone------------------------------------ ------------------------------------------------------------------------- r s - ----------- Owne� ------- —----_------------ -------- ----------• ----- -------------- ---------- Address- ---------------------------------•----------------_------_ ------------------------------------------------------- 0 ---------- 1406 ----i---------- .....7 -------------------- Contr�cf'r's Name_------------ P06-- , --------------- ------------q�hone............................. lnstallation will serve. 'Resiclencd-V,4artment House ❑E] Commercial ❑E] Trai er Court Ej Motel Other I . k— h El N6mber of living unsfr-.-�-_t.__NJMber of bedrooms -3--- Number of baths Lot size..a*41*( I\--3:g q Water Supply; jysteCiy: 1[ iblic !n,Rr_11( ommunity system ❑ Private [I bepfh`to Water Table ft. ! Character of soil fo' a gpfh ofJ3 feet: SandE] Grave Sandy LoamE] Clay Loam Clay ❑ Adobe ff/HardpanE] Previous Applicafioh,Made: (If yes,d—atte-------------- -..) No'V New Construction: Yes t? Nb [:] FHA/VA: Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic !A: Distance from nearest-w!-,Il-----------------Dista e4rom Ifoj44nda �Jb------------�Maferial-------- --------- - -0 No. of compartments-..- ------ ► m---------Siz ---Liquid dep+h,.z'-.---I--------------Capacity---Udi 777 1 ce rci,�Lfou11 Disposal field: CDisf?,,nc`e<fr'6_m,n4 re�sf weil-----------------Distan foundation__ +_-_-__ ---------Distance to nearest lot line____.� Number of lines---.----�/----------- _--------Length of each line-,X a",&Wiclth of french.. Typ e,of filter mat I erial.S_�e�.070i!W Depth of filter material____ -------------Total ,length___.____._----------- -------------- Jv Seepage Pit: Distance to nearest well----------------------Distance from foundation-_,:44.......Distance to nearest lot ....... Number of pits---- -----------------Lining material-----------------_----:Size: Diameter------------------------Depth------ ------------------------- 0 Cesspool -Distance from nearest well-----------------Distance from foundation_..._____..____--- Lining❑ material--- --------:--------------------- _j_' Siz'(�,qia m Ffe r----- -------------------- ----------Depth------------------------------------- --------_Liquicl Capacity------ _;-------------------gals. Privy.- Distance from nearest well--------------------------------------------------Distance from nearest building------------u________- El Distance to nearest lot line----------------------- ---------- Remodelingand/or repairing (describe):-------------------------------------------------------------:------------------------------------------------------------------------------------------- ----------------------------------------------------------------- -----------------------------------------------------------I---------------------------------------------------------------------------------------- ----------------------------------------------------- ---------1-------71--------- ---------------------------------------------------------------------------------------------------- ----- u ---- -----------------------------w--------------------- -------------------------I----------------------------------------------------------------------------------------------------------------------I.hereby certify that I have,prepared this application and that the work will be done in accordance with San.Joaquin County ordinances, State laws, arhd#ul6 and regulations of the San Joaquin-Local Health District. (Signed)__ ------- ---------------------------------------------------------(Owner and/cT-4Gen+ra*+ar)3 IBy:----------------------------------_---------------- -------------------------------- ---------------------(Title)--------------------------------------------- --------------- -- (Plot plan, showing size of lot, locatiori of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----AO�-k_ ---------------------------------------------------------- DATE-7Z_fO75/ REVIEWED BY-------------- -------------------------------------- - ----------------------------------------`------= -- ----- ----—,-DATE--------------------- - - . �i — ----------------- BUILDINGPERMIT ISSUED------------------I-----------------------------------------------------------------------:- --------- DATE------------------------------------------------------------- Alterations and/or recommendations-".......... ------------------------ ----------- ---------------- -----------------------------_----------•----------------------------------------------- ------------------------------------------------------------------------------- ---------------------------------------- ----------------------------------------------------------- ----------- ------------------------------------------------ ------------------------------------- -------------------------------- -------- ------------------------------------------------------ --------------------- --------------------------------------- ----------------------------------- ---------------------------------------------------------------------------------------------I-------------------------------------- ------------------------------------------------- --------------1----------------------------------- ---------------------------------- ------------------------------- FINAL INSPECTION_ByDate___ -0-------------------V. :r-------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California Fr. 9 REVISED 0-59 3M 3--b3 F,P.C11.