18191 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: � ZO -5----------- -- APPLICATION FOR SANITATION PERMIT Permit No. ---f�/j`/.... I '- ------ -------------------- --------------- ----- ------ (Complete in Duplicate) '" Com._ This Permit Expires :1 1 Year From Date Issued Date Issued _/'�_ =----------------- ---- -------------- - --- ----- 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. JOB ADDRESS AND�ATION--------------------- � ------ 0_?r!�0-- ----------- - -- - ---- � °.`r``` � ® f r Owner's.Name-------------�-N- --------` E� I - 7. L� - _,Plhone------------------------------------ Address �� J"3 � �}'Jl•�i�Q' p- - Y��E Contractor's Name------------- - ---- --- ------- --ta'-�--------- 11------ -- ----------------------------------------------- ------ Phone------------------------------------ Installation will serve: 'Residence grIA--partment House Commercial ElTrailer Court E] Motel [:] Other E]3_ Number of living units: '__ _ Number of bedrooms . .Number of-bath -s,'-2 Lot size . -,/•?v. VJ--P------------------------ 'I Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table, s ft. I Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ 'i Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe & Warpan ❑ Previous Application Made: (If yes,date-- ,--------------- ) No E4-'--New Construction: Yes [ Vo ❑ FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p 5e tic Tank: No} of coin artmentst well- D eahce from foundation�s0...-...__.Material-�C.�.r�.0 --------=--- - �~ P - yQ.Liquid de�h ' ----------Capacity� Q Disposal Fi d: Distance from nearest well___�'-Distince from foundation_��...-.----Distance to nearest lot line-.__.... Number of lines------ ..-----Len 'th of each line._...;-?S J_".Width of trench..R-Y-..�?._-------------- of filter material.. th of filter material----/Q '-----Total length---- �Il_�--------------------- Type _ . �/Z--A/rPlep l Seepage Distance to nearest well...------ .. Distance m foundation Distance to nearest tll t li� ' Number of pits------- Lining'materiaL.� AJC. -size: Diameter__-3.?.�.-----Depth Cesspool: Distance from nearest well-----------------Distance from foundation.------ ----------..Lining material--..-------._-_...._._.________- uid Capacity - ❑ Size: Diameter- - ------------- ----------------Depth------------------------------------------------ -- Li q P Y--------- ----- --------gals. �I ------------ _ Distance to nearest lot line.......................: Dis�ance from nearest building-__-...........____._.__-_.........____.. Priv Distance from nearest well_________________ Y' fI ❑ -------- ------ --------------------------------------------------------------------- ------------------- j Remodeling and/or repairing (describe):---------- --------- --- -- -- --------------------------- I -- --------- ---- --- - ------- -----•-------------- -•--------------------------- -------------------------- --------------- ---------------------------------------------------- ---- -- -- - - ---------------------- ------ ---------- ------------------------------------------------------------------------------- I1;------------------------------------------.------------------------------------------------------------------------ V. -------------------------------------------- -------------------------------------------------------------------------------------------------------------- ------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, ruAandre ions of the San'iJoaquin Local Health District.---- - ---------- ` Owner and ar Contractor(Signed)--------------------- -- -- -- - - --- - ---B i ---(Title)--- Y(Plot plan, showing size of lot, etn In relation do we'YS, buirdW s, etc., can be placed on reverse side]. t ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•- ----- DAT I ,� / ��f/ ------------------ REVIEWEDBY------------------------------------------ I ---------------------. DATE------ ------ ---------- BUiLDING PERMIT ISSUED -----------------------------�" J' fir-------� ---------- ----------------• DATE: Alterations and/or recommendations: . _��/.. I � 41-------� ---------�:._QlS"`��------------------------------ �. --------------------------------------------------------------- ------------------------ ------------------------------------------------------------- 3 — I 1 ......... ..........-------------------` ---------------------_--------.-------------------------------------------------------------------------------- ............................. . ........ ............... HNAL INSPECTION BY:-------- rI g. Date---. ----- jf �------- ------------------------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma=elton Ave. 300 West Oak Street s 124 Sycamore Street 205 West 9th Street S Stockton,California Lodi,California . Manteca,California Tracy,California i " F.P.CC. �I i °�