20491 - Laserfiche WebLink

Home Browse Search

FOR OFFICE:USI�-_ Permit No. _ --Qf? ' ------------------- -------------- -------- ;APPLICATION -FCR SANITATION PERMIT---------- (Complete in DuplicatelDate Issued � ------- " -' " ------- ----- F This Permit Expires 1 Year From Date Issued " A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe PP I Pad . This application is made in comple with County Ordinance No. 549` Aiin� r. 3-0-0---- PhoneW----Z ------Al up_P►�- - JOB ADDRESS AND LO AT10 1 . ------------------------------------ --- QQ ------•---------•-------------------------------------- ----------- Owner's Name -- ++ ------------------------------ ► Address----•------ = TI< I� ------•--- Phone---...---=�-��----•--•--------- Contractor's Name--------------- - i' -E -- " "-----"" " Motel Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ i' 14. -" Number of baths�Z�Lot size ____lJ- - "" " Number of living units: ---(---- Number of be _ t Water Supply: Public system ❑ Community system ❑ Private P-116ep th to Water Table -- ft. e I I. Character of soil to a depth of 3 feet: Sand�Gravel El Sandy Loam ❑ Clay Loam ❑ Clay E) Adobe❑ Hardpan C1 ew Construction Yes y lo.❑ FkA/VA: Yes�No El Previous Application Made: (4f yes,date-------- ) No`[ �— lYPE-OFTfI4$TA-LLATI'ON�'-AF4U''SPECiFICATIOIVS: [No septic tank or cesspool�'permitted if public sewer is available within 200 feet.) r ._ .. �_ � _ _T --------- 0 Septic Tank: , Distance frominearest well-_-5"�.---Dis$an e from foundation___ ,f I i .. r I Size___/ X _X_ __Liquid depth--------`y-- - Z 1_Capaci#y---- ------ „ No. of compartments .___� - -- -=- "# �c Disposal Field: Distance from nearest w II-_,��.-----Distance from foundation__/.�_Zy--Disfiance'to nearest lot ine---______________ ten th of each line_ 5 r�-�r-------- Width of trench_______._-��--------- Number of lines----------- - g �, ' Type or' filter material-__ �C De th of filter material-__._-1---------- Total length_.__ /_ _ -------- r _ P I b \ Seepage Pit; Distance to nearest well---=_kinin mat Bal Distance from found tZ�nDiameter_" D'stance-toDneepth-- lot line=_:.----.---- (� Number of pits.. ---------_-_. g ) ! ❑ a - � " Linin material.--------------------------------- nearest -- - ------ - -------•--- \! Cesspool: Distance from nearest well_- ___Distance,from foL_ tiat'-� -.--Liquid Ca' acit _________________---____._.gals. lSize. Diameter_- - - -------------------- F-1Depth a h-..� }tPv. \ Y . rI . - __ _Distance from earest'building------------------------------------------ Privy: �. Distance from nearest well_- _____' = --- ---- +.._ n __. 4 � �j t. . . - _=--`--; _-- ----' -- --- ---- -- ---- --- -- ❑ Distance to nearest lot line_ - Remodeling and/or repairing (describe:_.___ --------- ! /1-- - r I ------------------------ 1 y"kms ": _ = - " ---------------- --------------------------------------- j --------- ----------- = - ---------------- #= ----------- ----- __ _ ---------------�� - 1 hereby certify that 1 have prepared-this:applicat ion andthat nhLotalkHeall.be done in accordance with San Joaquin Coun#y ------- --------- ---------- ----- ---- -------"--- " �+ h�Distric#. t ordinances, State laws, and rules and regulations of the San q i + Owner and/or ContrI [Signed)- • �f- --- ,.,.M...�. = _ [ ----- ------ ---- - --------------------------------- [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place ort reverse si e. ONLY i FOR DEPARTMENT USE O �' ' -- DATE----- _ 5,.:� >� --------------------- 1 APPLICATION ACCEPTED BY_ �_h1-=-��` �-•-_ - ---- ----- DATE- - ------- ------- _. REVIEWED BY------------ ------------- ( � n------- ---- ---------- DATE-------------------------------------------- BUILDING PERMIT ISSUED----------r---------------------------------------- - m __ � _ - ---- l -------- --------------- Alterationsand or recommendations:------- -------- ------- -------------- ! --- - --- �---� ----- ---------- - *l` -- ----------- ------- - ------ --------- --- ---- ---------------------------- ---- ...........--------•-------• i- _ ----------------�11---/ `ti ----- l ----- 3 _____________ FINAL INSPECTION BY:" Date.------ ----- ------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naxeltvn Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Lodi,California Manteca,California Tracy,California Stockton,California f F.P.0 P. �I c