19003 - Laserfiche WebLink

Home Browse Search

-- D FOR OFFf�E USE: .i Permit No. - F------------------------------"----"--------- APPLICATION FOR SANITATION PERMIT --- •------ ---- -------- --------- (Complete in Duplicate) - --- -�- ---- -- - Date issued ---------�-�- ------ -------- ------------- ---- -------------- This Permit Ex fres 1 Year From Date Issued - - " 1_.P b made to the San Joaquin Local Heallh Disfiric 549 a permifi to Construct and install}he work herein described. Application is hereby This application is made in�compl�ance with County Ordinance o. RA r C. Thl - � _ RCS- = JOB ADDRESS AND LOCATION__-----.-�� --- �L�. _- Phone------------•--------------- QPD__ RSV .. - -------------------- OOwner's Dpi wner's-Name--------------7 ��A�.._.��14_.----- -- --��---••--�.,<..jAF-1---------•--------------------'----------'----•- Address_----- 57 ,/ -------------- Phone------------•-----•----- ---- Other ❑ Contractors Name----- _ _/h_ _.. .__-_.--------•-• Motel ❑ Apartment House ❑ Commercial ❑ Trailer Court Installation will serve: ., ❑ p fe�yy_ _. _.---- Number of living units: - Number of bedrooms __..__-- Number of baths WateoTakble J-_ ft. Water Supply' Public system ❑ Community system ❑ Private ( Dep Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ W PP Y Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Y FHA/VA: Yes ❑ No [` 1 No � New Construction: Yes �No ❑ f Previous Application Made: {If yes,dote"..----- TYPE OF INSTALLATION AND SPECIFICATIONS: oT"cesspa�i�p�rMied`if'public sewer is`available'within-2U0#eet:) C?4 CJ : - -__Distance from foundation-----fn----- MateZ-©ot�- Septic Tank: Distance from nearest well-______-_ - _ Ca Capacity No. of compartmen}s___.'- ^ ---- Size__�_�.__ISK..�.Liquid depth---=�--- ----- - P Y-•--• ,�— om foundafi _--__._.Distance to nearest lot lineefr--- -Cr- Width of trench--------A ------i--------- Distance.. I ' Disposal Field: from nearest well_"_- __�ength ofce reach I ne Jr --"---�-,Q - Q/ Number of lines-------_--- q- .K T e of filter material. Depth of filter material__---1./-- Total length___.________ p --- Type from foundation"____.--•------- -Distance to nearest lot line__-__---T!3-�?- Size: Diameter-----------------------Depth----"--------------------------- Seepage Pifi: Distance to nearest well__________-"___ --- I ❑ Number of pits_:-------------------- Lining mater'sal.-_;__ "_-- -- Cesspool: Distance from nearest well--------------=--DDistance from foundation-- -- _--_._Lilquid Capacity-----------------------------gals. i f- 0 Size: Diameter--------- -- -- ---- ----- ----- p : - } r nea ---------------------------------------------------------- i Privy: Distance from nearest well-------------- ----- ---- ----- ---- ------ ---Distance from nearest ui tin ❑ Distance to nearest lot line........................... ----- ------------------------------------ -- - -- -- -•-- ------ - i F- �— E cN I:nCl`_ L�'�`- ?5�7 f ----- '?� �' R _[ :..c7 - -------------------- -- ------------ Remodeling and/or repairing (describe) --- - ---------------------------------------- ------- _ --------------------- ------- ---------- _ --- - ---- ----------- -- ,.-_---________..___- -_ PP 9 `k will be done in accordance with San Joaquin County reby certify that I have prepared this application and that the war ri3lnances, State laws, and rules vegulations of the San Joa um Local Health District. (Owner and/or Contractor (Si ----i ----- a . . -r- ,,,,,_,tom.. .._=---.t,-------=-- ---- --- -- -- - ----- -- flot plan, showing size of lot, location of system in relation to wells, buildi s, etc., can be placed on reverse side). FgEPART,MENfOSE ONLY OR - DATE--------- -��-- � -�-�---------------- APPLICATION -------- -:;- . APPLICATION ACCEPTED By � � •.�_'--;-- ---"-- ----'-- DATE------------------------------------------- - --------------- REVIEWED BY--------------------------------------------- ---- ---- ---- ------ ----- ----- -- --- ---- - ---------- ---•----------- -- --- --�------- IBUILDING PERMIT ISSUED----------------------------------------- --------------------------------------•'------------------------------ ----- Alterations'and/or recommendations-------- ------- - ------ ----------- ----- -----------------"---- -� ------------ -------_ ------------------------------------------------------ ----------- -- ------ -------------------------------------------------------------- -- - t ----"--------_-------- ------------ _ -------------- -----_._-. 9 _ ..--- ---- - a 1 r Date-- FINAL ~ l INSP SAN JOAQUIN LOCAL HEALTH DISTRICT s' R a 1 fY 124 Sycamore Street 205 West 4th Street 1601 E.Ha:elfon Ave. 30o West Oak Street Manteca,California Tracy,California Lodi,California Stockton,California F.P.CO.