20888 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: p ---•-" ------"- ---------------- APPLICATION FOR SANITATION PERMIT Permit Na. .�D-�4_ ------ ------ ---- -------------------------------------- --,-_ (Complete in Duplicate) Date Issued -- ! -6� --------- ---------------------- ------ ' This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for„a•permlt t construct and.,insta work herein described. This application is made in compliance with County Ordinance No,,549. ✓ A _ a � :. s_ s,.F�// ,�: ADDRESS AND LOCATION-------�_4 -- ---7----._------------ 1p--- ----�----"--- _v--------- JOB --- ,� ; f .�A ' I /�'� &ls' Z ---- --"' ------------------------- Phone:c__s.. == Owner's Name--- =-----------"----- }fit //�� 1V ------------------------------------------------- -•--"--•-----•-------•---------••------- Address--------------•--' l� '� -------- 40- -------- ---- ----- _ r�Z t Contractor s .Name______________ ____ ___ __ �__ ,� - ;• � �. e .—A tra ment.House-, Commercial'E],—T..railer„Court ❑------ Motel Other ❑ Installation will serve: Residence ❑ p� �- , ! �- Number of living units: ___ _._ Number of bedrooms _`�� Number of bathe__.!_. Lot size __r},� '------ Q----------------- t• ► ' Water Supply: P, blic system Community system ❑ Private [] Depth to Water Table Aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob2.9y,1-1 Hardpan ❑ ,. +r I a .w i Previous Application Made: (If yes,date_- ----------I N;�o `/New Consfs k:tlon:,' --es+[�-No' FHA/Vs ❑ 'allo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittedif public sewer is available within 200 feet.) F Septic Tank: Distance from nearest well____________ _7Distance'from foundation___-.'__._______._.Material.____-.-_'_--...____..________----s._-------- ❑+ .U�w57�NCt No.'b#"compartments=_'°.`' "" `Size" ------- "-Liquid depth_= ;',.. j 'c Capacity r S `} r . l D's osal Field:. Disfance.�rom nearest welL1#_k�CDistance_from foundation-__'_--_S.=_'-----.---Distance to nearest lot li -- v �"c F' 'Length'..of each line----------- ` ;; •-------- !' Width of trench:._- : . r -.. I umber:of'lines-'--Y-::-_--- -'=- - C_-. De th of filter material__-_'-'_- „ -Total length_________'=-"'- -Q--- �� TYPe{'of fuer material--' --- -----' 4 p - Seep ge Pit: Distance to nearest well._. N.t'- ourjdation ____�p_.._.___.Distance to nearest lot line.___.-/ J Number ofr Its.__t_--- Linin materlal__,S.- ""_E Ize: Diameter------- pt'n__ -----'---aL '--------- Distance from fr.,, f , ._. De p g.{ t Cess ool:e Distance from nearest well-------------i-_Distance..from foundation- . material___=s.___.________.._-________.__.__ p € Size: Diameter = ' ' ----------- -Depth--------- ------------------------------------Liquid Capacit-'.. gals. ❑ �,-� ' Privy: �••1` ).Distance from nearest well-------------- "� rDistance from nearest building______..Y_I } i ."� Distance to nearest lot line------'------------- ----------------------- ----------------------- ----- ----- ------ ---- ------------------ -------. :� ;; - • - z _x_1 T.� r `-7- ---- -------- Remoceling and/or repelring'(descr�iJe�:_-- -_- �•-----:- `� = I } ------ i =ti 4 -------- ----- --- r1\h :." � - ----------•------------------------------ -------------------- -- ------------------------------ - it -------- �'° ' ------------------------------------------ f f ----------- s'---'- ----- --------- ---- ----- --- ------------- ---------- -- --- :... �- —� I}hereby ccertify that I have prepared this application and tha4 the work will be done in accordance with San Joaquinounty ordinances, State laws and rules and regulations of the San Joaquin Local Health District. I r l ---- ----.-" -----_._._-(Owner and/or Contractor) [Signed}_ _ 1 j II ---------------- - --- = '--- --- -------------- By: I 1 _ ------- ----'----- -(Title)_._ -- _ _ �:.. ; (Plot plan, showing size'of lot, location of,system in relat i to wells", buildings, etc., can be placed on reve rse s de}. c , FOR DEP.AKTMENT USE ONLY { { ` r DATE--------- ----------------- APPLICATION ACCEPTED BY__.----.-_._.___..-- - ------- --------- . ------ - DATE__.------ --.-'------ ------- ------ REVIEWEDBY--------------t-------------------'--------- ---- -------------------' -' t - t BUILDING PERMIT ISSUED Y. C = J ---- t DA Aiterations a� or recornmendatians:__.___.._ ?r.i - �_----------------i . � = ------- i -- ------------------- -•----------- _________________________ _Y'_.._____-_______-.--_____..--___._.__.__--__..._.___..__--__...___.___- ________..._.___________. - 1 ________________________i._____-_-....--.._____.-.___._._.._._____._-____......_..__...______...-.__: _ .- A ...................................................I_.-______..._._._________.--___-.-____--__._...____--.....--_____..---___._...__.___.._... ___.-___..____..._---.._.__.__ ' •w � � � � S r.crY M1-r..... "- -----"'--.i._ - _ _ _ _ ___ _ ________________11_-------- l FINAL INSPECTIONFBY `_".." ✓ cam'"`''�'"" at .- SAN JOAQUIN 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 F.P.CO.