14846 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE.. I >, '`�;------"- ----I` APPLICATION FOR SANITATION PERMIT Permit No. ..1-••- • = : ` ,—----- ___ ____ ___ ___ _________ "-- (Complete in Duplicate) Date Issued ----- This Permit Expires 1 Year From Date Issued - ----- --------------- ---------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w hero described. This.application.is-made in compliance with County'Ordinance No. 549. JOB ADDRESS AND LOCATION__._ i.b'--------LAY----- -LPQ ---RI?_._ --j1'f1-----1�------Q __.------ - �-- Q 1-_ V _� F-P------------ ---- ------------------------- Phone.'`_d•. Owner's Name___.___._-.�r.�___-- ..-•-•- 1 BD.x------ 3 Phone.. Ad ress--•------ - �� ...................•----•-----... Contractor's Name----_. _•"•-"s - `�'� """"""" i;1 Yom" i'"'"""` Motel ❑ Other ❑ Installation will serve: Residence Apartment Hous] Coinrneraal ❑ �reiler Court ❑ r Number of living units: __.l.--- ,N rrab;r of bedrooms . -- Number of baths _ - tot size .../z'°- -a - .. .•--..._ f Water Supply: Public system ,B. �om�-inMfi system C1 Private Depth ro Water able ft• Adobe Hardpan ❑ I Character of soil to a depth' 3 feet: aQd4Gravel ❑ _Sandy Loam �cley Loa W ❑ Clay ❑ ❑ No Previous Application Made: (If yes,date-------------------7 No E New Construction: Yes '� o ❑ F A/up"Yes❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I rr -4ni (No septic tan or cesspool permitted if public sewer is available Within 20 feet:} Se tic nk: D tante from nearest well-__ �____jDistanc from foundbtior�_jf '"� --.Mja erial__ �� p tp •ty'._./6s00... No. of compartments-----�--- Size L+quid depth---- ��--------Ca act ; u Disposal Field: Distance from nearest well_---: Q-_..Distance from foundationi -la—X � Distance th ofttre`h nearest ---- _ ___-._--..- 1\16ber of lines-------3------------------------ ----- Length of each line__ - v - - w ' -aTe'"ia ---Tofal len th_ � ______________________ sT1e of filter ma#erial,_&O_-"--}t.___"Depth of`"fil er—maTe' x 9 r' Seepage Pit: „Distance to nearest well--.___.._..___.____-Distance from foundation.................... to nearest lot line................. ' Diameter � _ Depth--------------------------------- Amber -----•--- •---••--•----------•- ❑ Number"of pits----------------------Lining material----------------------- ---------------------- I D stance from nearest well-----------------Distance from foundation-------------------- material__________________________________ Cesspool: -` .-gals. Si : IDiameter--------------------------------------Depth----------------------------------------------------- --------------•------•------------- ------- ----..Liquid Capacity-------•---------•-------• �. ❑ -------Distance from nearest building------------------------------ Privy: Distance from nearest well...__------------------- ---- ------ ❑ Dis}ante to nearest lot line.""-------------- -- - _ ; ' Remodeling and/or re a 9 (describe}:: -v. __ ------- -------- -------------- -------------...... ----- ----------------- ---------------•---------•------------ ...------------._...-----•--- I hereby certify that I have prepared this application and that the work will be done in accordance with San oaquin County ordinances, State laws,'and rules and aegulations of the San Joaquin Local Health District. __ ___________________________________ ____R_.._.__._-.___._(�-� (Owner and/or Contractor) [Signed) - Zt 46 -- -------- - B •------------ --- -------- ------------------- --------•----------------------------- [rtlel -- i e). (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed on reverse side. FOR DEPARTMENT USt``0(JL'Yx ,,1 ---------- ------------------------- -----------------------•---------------- DATE ---.[---- APPLICATION ACCEPTED BY-- - -��_�- - ----- DATE.�----t----------------•-----•------••---•------•------------ REVIEWED BY ---------------- ---------------------------- -------- ---------------DAT ._....--------••---_-_-_-•------• BUILDING PERMIT ISSUED ----_=-----__:---------- -- �- -"=Y' '-----...fs_^4.'_"-"---- -"---•.._ -----•-----'-----•-•----••----•------•.---••--------•'----•------- Alterations end/or recommendations_______________.---.- y 1Qt -t r 4., s f �sY ------------------------------------------------------ - --- •----------------•---------------------- Date--- -- ^------------------- FINAL INSP N BY: . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California E5 9 REVISED $-59 2M 5-62 ATLAS