20299 - Laserfiche WebLink

Home Browse Search

rvx UrrlCt USE: . - ------------------------ ----------------------------- r Y k -- ---------- --------------------- - - -- - ------ APPLICATION FOR SANITATION PERMIT Permit No. .-.. .l� --! F ---- -------- (Complete in Duplicate) ' ---- --------- --------- This Permit Ex fres T Year From Date Issued Date Issued Application is hereby made to the,San Joaquin Local Healfh District for a permit to construct and install the work herein described. • This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION_ Owner'sjo Name KFC a- Phone-------••- ----•----- -� -----.- I -------•- Address --------•- IQ-+ J9,/ �1---------------- �•• - Contractor's Name----------- •'� - ----------------------------- Phone.-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I---- 'Number of bedrooms '?"° Number -f baths ----(-_ Lot size ________'__.____ - - ---------------- ater Supply: Public system ❑ Community system ❑ Private Depth t Water Table ________ ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous'4pplication Made: {If yes,date___________ --------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OltINSTALLATION 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 _______ _ ----- ❑ No. of compartments--- -- ------------------Size-----• ------------- -----Liquid depth-------- Capacity Dispos ield: Distance from nearest well-SQ.�-_-Distance from foundation-----!_b_ _.._Distance to nearest lot line_�__P__---__ Number of lines-! -- J------------ Length of each line------- ----------------Width of french.---L-- ----------- "' Type of flier material------- of filter material_-__--�Q--"--_---Totai length_-_-____q:_u--_,--____- Se l Seepage Pit: Distance to nearest well------ _---------------Distance from foundation___________________Distance to nearest lot EJ N4mber Number of pits_!!_ ---_.--- ---Lining material___------------------ Size: Diameter-------- --------------Depth- ---------- Cesspool: Distance from nearest well-----------------Distance from foundation-._.________ - Lining material ---------------- II 0 5¢e: Diameter I-`----=-- ------------------------Depth--------- ------------------------- -------------- --- � Liquid Capacity------------ --------------gals. Priv '- ' - > Y Distance from;nearest well-------------------------------------------------Distance from nearest building---------------------------------- ❑ Distance to nearest lot line_______________ --------------------------------- ------------------ I Remodeling and/or repairing (describe):____' ------------------------------------------------- ---------------------------------------- ------------ -------------- ------------ ---------------- ------------------------------------------------------------------------------------------------------------------------------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e ws, and rules and lre ulafions of the San Joaquin Local Health Dis+rict. (Signed)----- ------ -- 1 ' - j' --.- ,. --=- --------' #� .- ..� � ._. - - and/or Contractor) BY: ( it T le)---------- ----------------- (Plot plan, showing size of lo}, Iota+io of system in elation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_ ' - ------------- ---------------------------- REVIEWEDDATE_ ._f -" -- ----------------------------- BY -------------3- ----------- --==------ ------- DATE------ -------------- ------------- -- --------------------------------------- BUILDING PERMIT ISSUED.--•------------}-------------- - -------------------------- -------------------•------------ ---------------------------------------------------- -------._ DATE------ ------------------------------ A aerations and/or.recommendations:__�___________________ - --------------------- ---------------- ----------------- ------ -------------------- 11 --------------- --------- ------------ ----------------------- -----. f s FINAL INSPECTION BY: /�° G ------- Date_.. _-� ��6 - ------------ SAN�OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avs. 300 West Oak\Street 124 Sycamore Street 205 West 9th Street Stockton,California ! Lodi,California\ Manteca,California \ Tracy,California F.p.co. •''�