21056 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------ ----------------- - ------------- __------ -- APPLICATION FOR SANITATION PERMIT Permit No. _12-/ .. (Complete in Duplicate) ��_ - This Permit Expires 1 Year From Date Issued Date Issued _ .. ______l ------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap lication is made in compliance with County Ordinance No. 549. i` = T "- - t '� ----------------------------------- Owner's T �---------- JOB A17DRE55 AND LOCATION----___�`�_�_.9�-t---- ----��X_`_ .��--- �-�:�-.°-�-- - �_(�,►-�_�-:.-----------------•----- _T_d-11-�1- i�._ - 1 �- ----- Phone. 1 IQ Owner's Name___�-�-�.---- -- =` Address.----•- L --- r • = ." �_. A�_I_ ----------------------------------•-••------------•- ---- I ` 'v�` _]. _i ��Q �r ...........•- Phone. 6`'?k_7.. Contractor's Name__��=__��.------ ��s= - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 1 Number of living units: ---I---- Number of bedrooms _-3;.- Number of baths -------- Lot size ----------------------�__. ---_._ '-------- ---- Water Supply: Public'system ❑ Community system ❑ Private ❑ Depth to Wafer Table�if_ ft. I� I Character of soil to a depth of 3 feet: Sand ❑ Gravel' Sandy Loam Clay Loam ❑ Clay ❑ Adobe- Character ❑ Previous Application Made: (If yes,date-- . __�'--------tNo,❑ New Constructio-:. Yes ElNo E] FHA/VA: Yes ❑ lI�No El TYPE OF INSTAL-CATION-.ASID-SP-FCIF.Icli-kT40 LS. -- _.- - - No septic tank or.cess ool permitted if public sewer is available,within 200 feet.) I' � P p_ , . P Lam'_ Septic Tank: Distance from nearest!wel�_----------------Distance from foundation---------------- Material_...__-____._.._________.________.__._.___..___. i (►ST, No. of com artmenfis-` , t - ._ Size __SA,�._:__ = =_=_Liquid'depth%�---------- - ---------Capacity----------I�------------ ri ,, Disposal Field: Distance from nearest well_>_(.�� .....Distance from%foundafiion:_'s^ ...--.Distance to nearest lot line___Z.4_ j g . e--- kX�S7. Number of lines--------------- _---:.- -- -------Length of each line--------- �-----------Vt/idth of trench.- _,:_;�.�------------------ Type of filter material----r;l Depth of filter material= ___�� --Total length__,._ _-_ _! ---.._-----ESeepage Pit: Distance to nearest well__ ____._Distance fromfoundafion ___ ______.Distance.to nearest lot linlA _--___9 s7. Number •f pits-----.. ..-- --Lining material--_ -4: Size. Diameter--_-- -_ _.Depth.. ------ ;00 mf ndation -_-__-^- _-__ tnmaterial ' `11, ----Cess ool: Distance fr , w _._Distance fro ----gals.0 Size: Dia eer- Depth Liquid CapacitY _t __-______-El (+ J,. . D.istance'from nearest b liu din Privy: distance rom nearest well .� �' �. g i 0 � Distance c, nearest lot line- _--_, ----- ------- � Remodelin and/or re airing {descrli�e):�- . -: -_ . rr' _. —' n ! - I hereby certify that 1 have prepared 4his application and that the work will be done In accordance with Sen Joaquin ordinances, tate laws, and rules and regulations.of the San Joaquin Local Health District. I �. � i t - � � ' r Si ned !'h��' --- - ={Owner;and/or CaI`tractor) ------- (signed) -_ - __._ tl---------- -- ' ------)Title)---- (Plot plan, showin size of lot, location of system in relation to wells, buildings, etc., can be-placed on reverse side). - .. 4_F.4R-DEPARTMEN-T-:USELONCY f I. APPLICATION ACCEPTED BY---------!--- -----------•------- - --- ----------------------------------------------- -- --- (T�-_- -�- REVIEWEDrBY�- /1 ' DADATE rJr 'r' - ----------- -� i BUILDING PERMIT ISSUED--------------- --=--------------------------------------------------------- � I ' Alterations nd/or recommendations---------------------- -- ------------------- --------- "/ M f 4 17 -----•----------------- ` - ---------------- ------------------------------------------------------------------------------------------- --------------------------------------------------------------- ,----------------------------------------- -------------------------------------------- --------------------- ---------------- -----------------iM------------- FINAL INSPECTION BY---------------- -• -------.------ Date------- - ------------ --------- t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street, Stocklonr California Lodi,California Manteca,California Tracy,California ? IN