20495 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USEv , -------------------------------------------------------- � 4�1. 1 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - --......- •----- --------------------------------------------------------- (Complete in Duplicate . This Permit Expires I Year From Date Issued Date Issued -_at -�,� 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. R% PQ t JOB ADDRESS AND LOCATION l 1Oh+ - -- --�-..-- ,r_----150-'----�-� � po Owner's Name------- --l---EA.13---------1��p --- --------------------- ----------- Phone-------------------------------- Address................ :. .-__.. Q -------3-b7-------- R1--4---¢N-'•--•------------------------------------------------------------------------•--•--------------------.... Contractor's Name NTN4 `-------------------•------------------------------------------------------------------ Phone----------------------------------- 4 Installation will serve: Residence Q"'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /----- Number of bedrooms 3--- Number of baths Lot size -AA _ ---------------------_______ Water Supply: Public system ❑ Community sy em E] Private Pg- Depth to Water Table J _ ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam L❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date--------------__.._} No New Construction: Yes E] No 2 FHA/VA: Yes ❑ No [6{� TYPE OF INSTALLATION AND SPECIFICATIONS: f � (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest,ewell_____;-------Distance from foundation___................Material________.______.__________________--.--_______- N C- No. of compartme n ts-------- ------ --------Size------•--------------------- ---Liquid depth------ ------- -----------Capacity----------------------- Disposal Field: Distance from nearest well___5_d-----Distance from foundation---- Q---------.Distance to nearest lot line__'----- �� Number of lines---------f-----------------------Length of each line-----_-�-----------width of trench------ r�� -__------_ Type of filter maferial___R_0_C_K,__Depth of filter material ._.__f-9- ------ ---Total-length_____________7 ---__________________- T. Seepage Pit: Disfance to nearest well_____._______________Distance-from foundation_-_=._...___.1.__-.Distance�to nearest lot line___-________ ElNumber of pits----------------------Lining material ----------i_,-_-i----Size: Diameter--------_--------- ----Depth--------------------------------- Cesspool: Distance from nearest well----------_------Distance from foundation__._____-_---I --_ Lining material__.-_---.___------__--___._________ El Size: Diameter Depth Liquid CapacifiY---------------------------gals. Privy: Distance from nearest well----------------------------E--------------------Distance from nearest buiiding--------- '__._____________________.-------- ❑ Distance to nearest lot line-------------------- ---------------------------�-------------11•----------------------------------------------------- --- --- Remodeling and/or repairing (describe):---- -------------------------------------• r -- L !♦ ,-- - - I --------------------------------------------------- --• ---------------------------------------------- 0016 R - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and rules a"d regulations -of the San Joaquin Local Health District. (Signed] m----------------------------------------------------------------_ -(Owner and/or Contractor) By:------------------ --------------------------------- "'if""i--Rte-------------(Title)---------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed cn'reverse side]. FOR DEPARTMENT-USE ONLY. APPLICATION ACCEPTED BY DATE --S- 66 REVIEWEDBY---------------------------------------------------------------------------------------------------------- -- ----- -•- DATE---------- -------------- --------------------------------- BUILDINGPERMIT ISSUED-------------- ---------------------------- ---------- -------------- -------------------------------- DATE----------------------------------- ----------- Alterations'and/or recommendations:--__---_-.--_. -w _.--- - •---•----- ----------------------------------------------------------•------ --------------------------------- --------- ----`----------------------- -=----••-----------------------------------------------• --•------------------- --------------------------------------------------------------- - ----------------------------- -- F1NAL INSPECT( Date = Z6 ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California