13834 - Laserfiche WebLink

Home Browse Search

R OFF �lJ E f 1 Fo SANITATION PERMIT r I t ' --------- FORSA Permit No. . - - IC 5 J APPLICATION This Permit Expires 1 Year From Date ;Issued / - (Complete in Duplicate) Date Issued, �• ----------- �. ------------------ ---------------- Application --------------- A A lication is hereby made to the San Joaquin Local Healfh.District for a permit. `o construct and install the work herein described. pp a with County Ordinance No. 549. This application is NDdLO c T10NncQ__964 `�� u JOB ADDRESS A -- _---------- -.. ._ .: �� _ -ti_�_:L_0......___ i =--- - h Ci 12 t�:.l -` ------•----• -•------- `, one_--_- ---• .•....--•--•-- I Owners Name-------------- C_--i•�'•.........----............. p € ! D I'� _ .� :_: ' Address----- ._.__....-- --------------- --- - - -:..... ------- ---•---•- IContractor's Name_.------- ��t� �........e�,At—_-------•--- ------••----- ----------.--•---- --•••---•----• Phone-----.----------------- Installation ._--Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Eg -....__ 3 Number of living units: ___'Z P Number of bedrooms ____ ' Number of bafihs _____.. Lot size __�r_----------------• - - Water Supply: Public system ©,Community system ❑ Private ❑ -Depth,to Water Table-�S__ ft. k Gravel Sand Loam ❑ Clay Loam ❑ Clay❑ Adobe 0�Mardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ / Y ,�, � l Previous Application Made: (if yes,idate-----------_--------) No ©',New Construction: Yes ❑ No L�KHA/VA. Yes ❑ No Q�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance-from nearest well------------------Distance from foundation--------------------Material------------------------------------------------------------------ ...... �,: --Liquid depth ---Ca Capacity IEV { ��- No. of compartments-----------------•-----••-Size-.------------- l. Disposal Field, Distance from nearest well--___`-------_.Distance from foundation..__J<2__....___.Distance to nearest lot line...._........ d / •1/2 ---------••---- 1 _ --1----------------Length of each line-.-----,/ ------------- Width of trench---.._�. 0- 4_1L, Type of filter matenal/. -"i-Depth of filter materia!____/_I--------------Total length______. �'- ----------.-- Seepage Pit:" Distance to nearest well-----------�------Distance from foundation=..._1 '-..-._._.Distance to nearest lot Iine. .____.-__.. p s___----I------•------Lining material..Y c_-._1.� Size: Diameter `�-S��•• Dep+h Cesspool: Distance from Number of it f p ,. r on- --•---------.Lining material------------------------------------- i p nearest well_________________Distance from foundati `,. dls. ❑ Size: Diameter----------- ----- ----------•-----.--De th-------------------=- ----=- --------------------Liquid Capacity. 9 Priv Distance from nearest well------ -----------= ----- Distance'from, nearest building-------------------------------•---------- Y ❑ Distance to nearest of ine__________------------______------------------------------- 77 4.. ... ;e i Remodeling and/or repairing (describe. :_-- ' ��`""= ' - - ------ --- - ��lJ~ s. - _- - his a hca+Ion and that ----- I hereby cern#y that I have p p pp hat the work will be done in accordance with San Joaquin County A, n Joaquin Local Health District. � ordinances, State laws, and rules and regulations of the 5a . La/ -^,/--•-- (Owner and/or Contractor) (Signed)-------•-•------••---`-• - -----•---- .--��- - •. ' ` -�/s -• -1 -------------------- -(T+le)------ � �S'`p �'' -----• *.-.;- "b i By:------------------ a l (Plot plan, showing sire of lot,il cation t3f system in relation to wells; uil"in s, etc., can be placed on reverse side). L ,. F-R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. _'. .- 1�� ' == DATE--------- =,1-%..� -.��---- i �- REVIEWED BY DATE---•------------------•-------------------•--•-------- - -• BUILDING PERMIT ISSUED__l-------------------------------------------------•----------•---------- ------------------ -----------------------•------------- Alterations and/or recommendations---------------------------------------------- ------------•----•------•--•--•---•----------•-------••----------------------•---•-------•--=----•,------------ -----___------•-------•----•---------------------------- ----------'--------------- ------------• ------------------------------ - .......................................... -- _. ------------ --- ---------------.----------------------.........I-------•••--• - _, k ---------------- ------- ---•------- -___.. Date--------•.--~�- FINAL INSPECTION BY.:-. - I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Went Oak Street 124 Sycamore Street 205 West 9th Street ! Trac California Stockton,California Lodi,California Manteca,California Y, 16 9 REVISED 5-89 2M 5-61 ATLAS _