21109 - Laserfiche WebLink

Home Browse Search

vim v' i 1�.L UOr: -------- -- ----- ------ ._______ APPLICATION FOR SANITATION PERMIT Permit No. ��1� __ --------------------------------- ------------------- -- (Complete in Duplicate) ------""--"" -------------- ----- ------- - This Permit Ex ices 2 Year From Date Issued Date Issued --- Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance,No. 549. 4f 20,e Al- nJ to 4 ca , JOB ADDRESS AND LOCATION------- 49----- / 32 - 4Sa.- Q2 Owner's Name-------- _ 1• -------------------- -------••---------• =-- PhAddress � - - '{�../ � ---- � -------- ----------- - ------ "--•----------Contractor's Name____ _ / N Installation will serve: Residence [I Apartment House [] Commercial ❑ Motel Q Other fill _ Number f living units: 15M*� Number of bedrooms Number of baths __._ Lot size Water Supply: Public s pAIYy ❑ Community system 0 Private Depth to Water Table ------ ft. Character of soil to a dept 3 feet: Sand p Graved ❑ Sand Loam Clay Loam Clay sa pp Icatio M " I y - • 1 ❑ Y ❑ Y ❑ dob o Hardpan ❑ Previou A 1 �y,�► es dl .,yes, e--------- ---- -_-) No ❑ New Construction; Yes ❑ No ❑ FHA/VA: Yes D No ❑ TYPE iF STLLA`FION AND SPECIFICATIONS: # �'" oseptic tank or cesspopl.i5t miff d if public sewer is available within 200 feet. Septic Tank- .t .Dis aaGe f„m*n7e rest well A/rodation Size________ Liquid dep t-h.--------No. of comparfiments_._ ...r Dipsa Field: Distance fromnearest well_. Dstance from foundationh.� -- ---.DMisattaenrciaef_.tfo nearest i i cloitty/.line_-?_Xp` Number of lines--------------- --Length of each line------- f� 1 . : Type of filter material___ _ s !Nldfih of ""__.-__ " i 'rl f r Yp /�� --- Dep#h of filter material-----.-f� --.---Total length---.--1�_,�,�------------------------ p f f . � See a ePit'i ---Distance to nearest well_.__ __""- Distance fr fo}ndation_!" �� -___._.pistance to nearest lot line__�f�__s___ Number of pits_.____.__.._. ___Lining material__ - -ill. ( ?' " `/ / C�` » s ! ., "" T . . - Srze: iameter----- a ss�ool; ` Distance from nearest well_________.___-_3Distance from foundation_____________ ------.Lining material ./------------- Size: Diameter ------------Depth--------------------- -------- - " ________-______.Liquid Ca aci Q p (tY,'--_----- •--------- ----gals. Privy: ,Distance from nearest _________# _ -Distance from nearest buildin F-1Distance to nearest ]of li e - g �... ' ; Remodeling an /or repairing (describe):_-- ~'- ""� r ----- -- - ----------------------------- ---- rte / ----------- ----��--------------------------------- ----------------------- ------ -��--_-- ---------- ------------- -- ----------------------------- ---------------------------------------------------------------- Ii I hereby certify that I have prepared this applicafi n and that the work will be done in accordance with-Sari Joaquin County ordinances, State laws, and rulesandregulations of A San Joaquin Local Health District. ` (Signed)------------ I, ----------- ------ ---- --- -__._ _.__-(Owner and/or Contractor) - -- ------•--- -------- - Y ------ -------------------------------------------------- ----------- ------------------------------------(Title)- --- (Plot plan, showing size of lot, cation of s stem in re 'lion to wells, buildings, etc., can be placed on reve a side]. t FDRj ARTMENT USE ONLY APPLICATION ACCEPTED BY---------M----.---- ----------_ Gam/ q ' - '----------r--- //-��------ ----------- -f ---�� ---��----'--- -'-• REVIEWED BY--------------------------- - ------' ---- - ------ ---------- �f ----- DATE-----' C � --------------------- DATE----- ---------- ---- ------' .__��_...------------------- BUILDING PERMIT ISSN.IED-------------------------------- --------------- terations and/or recommendations:_____..___ ------------------------------------' - ------------------------ ----------•--------------------------- ------------------•--------- ------------------------------ ------------------------------------- ---- ----------- ----------- _ " ---- - '--' - ----------------------------------- ----- ----- ---------- -- - -------------- ----- - I) / : FINAL INSPECTION BY:__hl.II�.G�/ -- - ate-'----- ----'--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p,E a.