20859 - Laserfiche WebLink

Home Browse Search

rUx (_kH t ubt:: �« l� /oo f' =i �1 �} -------------------------------- APPLICATION Fb:R_,SANITATION PERMIT Permit No. ._u` �s - -- -- --------------------------------------- (Complete in Duplicate) Date issued --------------------------------------------- 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 in compliance with County Ordinance No. 49. JOB ADDRESS A L CAT N ----A-^--A---�----/---- //e Owner's Name - -------------- J-� i4t, r' J_-- Phone49'�'"-= Address i_ �� - "-ice -- ------------ --�--------------------...---.--.--------------------------------- ----------- ------- •- --------------------------_ -Contractor's Name._ pt, , Phone=_ �?_ installation will serve: Residence �pa.rtim -f.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _._ Number-,of bedroom__ Number of baths ___F--- Lot size _---� --- _/�_�•r___--__� -elc Water.Supply: Public syst mi El Comm"uur�ity system E] PrivateX Depth to Water Table -------- ft. Character of soil to a dep+h of 3 feet:!'and ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardy [I Previous Application Made: (If yes,•d'ate_-------------____J o ! ., New Construction: Yes E] No E] FHA : Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if pel@ic sewer is available within 200 fee t.L Septic Tank: Distance from nearest well ---Distance from fc, ` ,anon-___________.Material__. ---______________________ No. of compar erfts-=-r-------- -------Size3kf__1NC6S__Liquid depth_�I._---..._.Capacity_y.�� r Disposa Field: Distance from nearest well-------- -------Distance from foundation-__.----------------Distance to nearest lot line-------_-__-_____ ❑ Number of.line---- ----------------- ---_------------- -- ..---:Length of each line----------------_-----_-------Width of trench.------------------------- ---_. a Type of f•I,ie a.terial'__,_. Depth of filter mafeTia`I""`.---7! 7"!-T otal length__________________________--ro-- J Seepage Pi� i Dstance Sol n�a,eesst well_ �__�_- Distances from�founciation___________________.Distance to nearest lot line----------- ❑: Number of Api�s' -- -- f'_ ng material---------------- -----Size: Diameter----. ---------- --- Depth------------------- _-----• 6 1 Cesspool: ,g Distance from nearesftwpil-----------------Distance from foundation--------------------Lining material--------.___------------'--'" -_-_-_ si ❑ Size: Diameter----- ---------•eII:�E----------------------------`-----------._..Distance from - Lriquid CapacitY----------------------._. gels. D ` _ s Depth ------------ --- --' "� ,I Priv istance from nearest w r� ' nearest buildin }} l ❑ /Distance to nearest lot''bine"' r_________________ "'____.________ _______ �------------ ------- ------------------- ----- 9 / repairing 1 Remoaelin and or re airin describe :- -- -- --1--- ` ---- -- ----- ------------- -- -------------- u ; fill -------------- -------------------- -- { -------------------------------- -------- ------------------- ------- ------- ----1.-_----------------------------------------------- ------------------ --------- -- -- ---" *- - ! reby certify that L.have prepared this applica+'on and tha+ }he ivor�k,��will•be-done-in accordance with San Joaquin County ce ordinans, State laws an rules and regulations o e San Joa u' L I�Healt istric+. ( x (Signed) � `�"J;��, ... . t....... ---------------- -- onfractorj /f-------------------------------------------- ------- - _______Title --------- - (Plot plan, showing size of lot, location of system in relat' to wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY"`---- APPLICATION ACCEPTED $Y r ------------ - ---------------- -- -------------------------------------- DATE- - ~ -r------------------------ REVIEWEDBY------------------ ----- - ------------- --------------------------------------------- DATE------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------- --- --------------------------- Alterations --------- }Alterations and/or recommendations:------ ---- ---------------------------------•------------------------------------•--------------------------------------------------------------- :; -: : ' ----- ------ ---- - ----------:::: & -�-�: FINAL INSPECTION $Y:- ------------- Date - -1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California r.P.CO. t' i