18507 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------- ------------------------------- " - - ---------------------------------------_-.------- APPLICATION FOR SANITATION PERMIT Permit No. .._.,1. 7. - -- --------------------------------------------------- (Complete in Duplicate) Date Issued -- '/ - -------------------------------------------------------- L 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 work herein described. This application is made 'n compliance with County Ordinance No. 549. t G�(p v ZOO- �{7 t>= .� JOB ADDRESS AVIV LOCATION-- / � 7� ��TI`� - -(- 4 [gip Owner's Name----------------)- F-------5.r7-0Q1)1.N-6r-----`•------ -------------- ---------------------------------------------------- Phone-------------- --------------------- -------�--------------- Address - --(1.�_' �_ .� 5 K Contractor's Name---- .RRA FaA E.R'- ----------_-------------- ------- ----------•------- -------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House r] Commercial [❑ Trailer Court j Motel ❑ Other 0_00Pj-F-X Number of living units: _. _ Number of bedrooms � ___ Number of bat Lot size ___i__7S X /S© Wafer Supply: Public system ❑ Community system Er"Privatet] Depth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand //Gravel ❑ Sandy Loam ❑ Clay Loam ❑ flay ❑ Adobe ❑ Hardpan C]Previous Application Made: (If yes,date____________________) No .[i- New'Constru`ction: Yes�1Vo E] FHA/VA: Yes ❑ No E3- TYPE OF-INSTALLATION-AND SPECIFICATION Se (No septic faW or cesspool permitted if public s WMW available within 200 feet.) Se t' Tank: Distance from nearest well__ ___.,,_bistanc from foundation_.___ p ` 1 UMa#e ial..�QN. _ r ------ No. of com artments_ � _ ._ _ _S e_YKI_P__x__-2_'_Li uid de th__=1Capacity---/ Q' Q p q p . _ '- � t t � Disposal Field: Distance from nearest welL_____�_.w'_Distance from foundation----1162-------.Distance to nearest lot Number of lines-----------~.eL___----------------__Length of each line__* p_7t_7 _.Width of rench_1__ -"- --------- y --- Type of filter material-_Q.(C)0<,__Depth of filter material----/'7__`_`______Total length---------- J-_Q------------------ Seepage Pit: Distance to nearest well______________________Distance from foundation______.-.-__.-___-_ Distance to nearest lot line----------------- ` El Number of pits----------------------Lining mater'ial---_------- "Size:-Diameter=--------r------------Depth--------_----------------------- V Cesspool; Distance from nearest well-----------------Distance from foundation--------------------Lining material__._.____________.______--__-____._ �1J ❑ Size. Diameter--------------------------------------Depth-------------- -•-----------------------------------Liquid Capacity-- ------------------------gals. 4 .w, .. t�..,. 4- Privy: Distance from nearest well_______________________ "` . W__-_ , Distance„-from nearest building__,_.___________________________.____.._. ❑ Distance to nearest lot liner '" -------------------------------------'-------------------------- --------- --------------- Remodeling and/or repairing (describe_--------------------------------- _ . I, . --------- ---i-- -------- --------'--- - ------------------------------------ - ------------------------------------------------------- ----------- --------------------------------------------------------------- --------------- ----------I------------ ------------ -------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Sari Joaquin Local Health Distlicf. (Signed)-•- -- ------------- � - ------------------------- -------------------------------------_- .-.-----(Owner and/or Contractor) BY ---- - ----t------------------ --•--------------------------------------- ----------------------------------------------_(Title)------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). IF J ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ..:............. . _ .. . DATE--------- r —-------------- REVIEWED BY---------------- ------ ---------- - -- - ----- - -- �-- r e-------------------------------� -DATE----- - ------------- r BUILDING PERMIT ISSUED---- �'I �� -•------ ------------------------------------------------------ DATE---------------------- Alferalions and/or recommendations:-------ZEA-�.H----._�_L-NP—.,S-------.-- _,_� ------1 CI'�_f=L - .__Te_I .- :---.----- -------------- ----------- ---------------------------------------------------- -------- -----------------------------------------------------------------------------------------------------...----------------------- ---------------------------------------------------- ---- ------------------- - ------------------------------------------ ------------------------------------------ ------------------------------ FINAL INSPECT BY:. _ . . .. . - --- . -- --- ---- -- - --- Date-------------..-- -4-....-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Streel 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.