13519 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 30 /o�a---•,_-.-.�'��6��_- APPLICATION FOR SANITATION PERMIT Permit No. ------------ ----------------- ------------------------ (Complete in Duplicate) Da e`Issued ._ ..�_{ c(._ I. '' �- This Permit Expires I Year From Date Issued --- --------------- ------------------------------------ Application is hereby made to the San Joaquin Local Health District forper to construct and install the work herein described. This application is made in compliance with County Ordina ce No. 549. JOB ADDRESS AND LOCATI N-------- ._/-_ ........ ------ •------ --------•-•-- ------------..._ _... •- ----- - - - ----- P one. d Owner's Name = ------•-•-------- f_ .. � 7 K --- ---•---- . -----------••-•- -- ------- r Address------------------------------ ---=- ..........��----- - ----- --- ---------a-----------�-�•-7--------- ------...._ Contractor's Name------ --- --------- �'------------ - Phone. -------------•------•------------ Installation will serve: R idence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ A -- daares`s �r rNYm�,arr gf��l?S.g�... Lot size.__5 4�_K `S� Owner's iVame '�Ad��r.',.,,�Jrf6+v �l•,v/��-F -y�y�_ Arir�Ps.� �� License No.�;k_g 7tra��Phone T,6�� Character of sail to a depth of 3-feef-. bang {� ravel Li Panay �� may s ua�r� LJ �-'pr u _ C Previous Application Made: .(If yes,date-------------------) No &r New Construction: Yes ❑ No FHA/VA: Yes ❑ No [ [ TYPE OF INSTALLATION 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---------------.--------------..------------- ___. p Liquid depth-----------------------__Capacity---- ----------------- ❑E�XaSfrN� No. of com artments___•----------------------- ize_.._.______•-_"----__---- - --- - Disposal Field: Distance"from nearest well__/�4VG-Distance from foundation......�P'_..........Distance to nearest lot Number;of lines-----------_____/_____- -.__--_ Length of each line---------c;00...............Width of trench--------- f_-_______-..--- Type of filter material____Depth of filter material----.__ _________Tota! length___:._.-____( ______..___________. I , Seepage Pit: Distance;ito nearest welL_)4N_.0-----Distance from foundation-_ ------:---.Distance to.nearest lot line-47._ [ Number:of pits.--->77M_CO-Lin ing material---6-6 jC�_,-----Size: Diameter--- Depth_____7-5_-� Cesspool: Distance from nearest welE-----------------Distance=fromfoundation.._.__________..-__.Lining+dCterla__..____.__.___._._____....._.__a__ls._. F1Size; Diameter--------°--------------- ---------- Depth----------------------------------------------------Liquid Capacity_..._..---------••------•_-9 \ ` Distance from nearest well-_-.-a--------------------------------------------- to ---------- -------------- - --kDistance from nearest building------------------------------------------ Privy: ❑ Distance to nearest lot line------------------------- ------------ - - -------------------------- •----------------------------------•---------..._------------------------I---•------------ Remodeling and/or repairing (describe):------------------------------------------- ---•- --`--'-------` --------- -•-------------------IL-------4-------------------------------..._.-"-._._--------------------•----------- f ---------------------------------------------------------------------- -------------------------------------"_------__-.-----_____-_----___.---.-_-___.._-_-_...__-_._---_--__"_----____.-_------.._--__.---_--_ I hereby certify t have prepared this application and that-the work will be done in accordance with San Joaquin County ordinances, State la s, d rules and r gulations of the n Joaquin Local Health District. . i' i Contractor) (Signed) .1 -- --- -- - ---- e and/or tor) I B ' ------.C `- - ------ - -- (Ti I %I r __[Owner 1/tA �.��------ -- tle /�l By: :---• I (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be place4,6n reverse side). i. FOR DEPARTMENT USE ONLY II APPLICATION ACCEPTED!BY y��------ "r~ DATE ___�`_I rte' REVIEWED BY -'-- - DATE BUILDINGPERMIT ISSUED------------------------ -------------------------------------------- DATE------------------------------------------------------------- ` AlteSation and//or recommendations:--.-__.._"---- .---...._ - 4 ---1-�' ____________ ____________ ______ _________-_-___.__________________.___ ___:.-______...__---._------------------------------.-----------....-.--___----_...._--. - ----------------------------------------------------•--------------------------------------.__...---------------------------------------------- Date -------- ( FINAL -- _ INSPECTION BY: Date----- `�/ j�� i. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ' 300 West Oak Street 124 Sytornore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5.9 REVISED 6.59 r.F.r D.2M 6.66