19578 - Laserfiche WebLink

Home Browse Search

roti ut-rl:a USE: « �w r ---------------- s ----- -----------;----------------_-._____---__.._______- APPLICATION FOR SANITATION PERMIT Permit No. -------------------- (Complete in Duplicate) fires Year From Date Issued Date Issued -- r � .:.. This Permit Exp I' �2_&''Y7p�'7 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. N ;31DC- � y f . . � 2►�� i I Pol`I �� JOB ADDRESS AND L CATION-. -AM-------t'�-(_tP_o_(�I � t1Q[ �------©��H_A_��------PA_RK-----No� op, Owner's Name- �.Q- # w ! N•--F------- oV._�--=--- - - ---------------- ----- ---- ---------------- -- ------------ ------ Phone._ _y__��3_q Address T _r- Q �... ------- N---'---- - Contractor's Name------------- Q _ _I=1 ------------- --------- Phone..__.. i Installation will serve: Residence ❑ Apartment Hlouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [�j` WORK SHa Number of living units: _ : Number of bedrooms Number of baths __- ___ Lot size ------- -}=C[5_ _t= �z Water Supply: Public system 'Community, system ❑ Private F Depth.to Water Table _lift. Character of soil to a depth of 3 feet: Sand (Gravel ❑ Sandy Loam ❑` Clay Loam ❑ Clay ❑ Adobe p Hardpan ❑ Previous Application Made:, (if yes,date________________ __) No O.�__New Construction: Yes ❑ No �HANA: Yes ❑ No 2' TYPE OF INSTALLATION AND SPECIFICATIONS: (No sep'tic;tank-or-cesspool-permitted-if public-sewer:is-available--within,200 feet.);- u ;5epfifcink Distance from nearest well---- _Dist an�e from foundation-----/0-- ._. Material.._ HFP.tWUOp-.-, x � No.•-of-com artments_____. q p 1 Size X lv Liquid depth �� CapacitY �Q- --.. _ �; Disposal Field: Distance from nearest well.:____Distance from foundation____ } / /-r ._.Distance to nearest lot line___-�_..____.___ [+� Number of lines--!---------j•----_-------------Length of each line--- f ------ -,,-,-,Width of french------36,-1 ---------------- -- Se yp l g ------------ u r--t� --- T e of filter material.__. - QC Depth of filter mater al_______�__ __._._ ._Total len th________._�rJ __.____ �« epage Pit: Distance to nearest well __J'�fl_- Distant from foundation____ _ D�stancg to nearest lot lme__.�?___ U { „' Number of pits__.'_/____- ___. Lining material_LIROK�� Size: Diameter.__ (� CotU�( � X Deptn. ({ II Cesspool: Distance from nearest well_________________Distance from foundation._____---- --------- Lining material_____.._.__:------------------------- ' ❑ Size: Diameter-----=- ------------------------------Depth------- ------------------------- - ------- -%----Liquid Capacity --------- :---------gals. � Privy: Distance from nearest well---- ----------------------- ---------------Distance from nearest buii0ing------------------------------------------ - � ❑ Distance to nearest lot - s� - line-----_---------------------------- -------------------------------------'---------.----- I Remodeling-.and/or repai'ring (descrb.er---_---_-- ---ti-- ----- -- ---------------------- ---------------------------- � N = I'D1T ----- L----- -------- A ------ " - T -. . S, n _._ . -H1 TP= r ------------------= I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Safe laws, and rules ;and regulations of the San Joaquin Local Health District.- (Signed)--- __ ----- -------------� ----------------------- ------------- -- ------ ------ $Y� ----- ---------•-- ----------------•------•------- ------------------------------------------------ ------ --------------------:-_- caner and/or Contractor) Plot Ian showtn �, -----------(Title)----- •---•------------- -- [ p g sae of lot; locatio z of sysfem in relation`to�wells;buildings, etc., ca a place�f on-reverse-side).j w" :-- FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY-------- �11=��---•----- - -- - ------------------ DATE ---- -/S-- 5. - -- - ------------------------- -- REVIEWEDBY-- -----------------------------•----- 4 ------------------------------------- --------------------------------------- DATE-------- ----- ----- ` . -----------------=------ BUILDING PERMIT ISSUED =I------------ ---- ----- DATE -------------- ------------------------------------ ------------------------------------------ Alterations and/or recommendafions:__ _.._---__._._._ - --------------------- --------- - ------------------- ------------------------------------ -------••----------------------------------------------------------------------- - ,. ---------------- ----------- --------------------- ------------------ ------------------------ /�7 y FINAL INSPECT ON BY:.- bate L/. i i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kpxetten Ave. 300 West Oak Street 124 Sycamore StreeTt 205 West 9th Street Stockton,California Lodi,California Manteca, California Tray,California F.P,CL3. - t