19194 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- ---------------------_---------------_.._ /_e . APPLICATION FORRSANITATION PERMIT Permit No. .. --- --- - (Complete in Duplicate) ___ �. Th_is_Permit_..Expires 1_Year_From_Date Issued Date Issued __ T ,. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with u Sr*nance No. 549. JOB ADDRESS AND LOCATION ----- ---------------" Owner's Name--TT? - - . �'�- *. 4 -._.__.- _. _ r- ,---D-- --- -•---------- ------ --- -----------------------' ------ Phone------------------------------------ Address ... ------- ---------------------------- Contractor's Name -------- ---- ---------------- Contractor'sName------- ° - --------------.'Phone----------------------- --- Installation will'ser*e: 'Residence E�' Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelEl `-Other ❑ :.._ Number of living units: _______ Number of drooms __ Number of baths �__ Lot size ---- __._ F--R - �---'�—d-�------ -- ------------ it Water Supply: Public system ❑ Community system ❑ Private /Depth to Water Table err' ft. Character of,soil fo.a depth of 3 feet: Sand ❑` Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application,Madel ,(+f yes daFe _. _.>__:__-r-No- - �-•New-Construction: Yes ❑ No Yes F+., o❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic_tank._or_cesspool-.permitted if publicriewer.is available within:200 feet.) t :' �. NDistance from rearest well__ ---_i Distance from foundation__ . __ _Material____4C___�?___goge, K ______. Se tic Temic: of com artments_____ Size_ =_Li quid cue th �_ __" 1_ p �; p + _-q P.. _-Z— -Capacity..... �` Disposal) field:' Distance from nearest well'` *Ifs Distance from ffoundation_1 _.- .Distance to nearest I� linea Number' of lines___'_____ line_____ r �� _ `Length of each;3 'f_� -�,�Width of trench: ._._3� ------------- Type or filter material___ L-z_D Qe{�th of filter material__ ._ __�_ �.__ Total length------ __- ..___. ` _ rt See a ;-_T_:� • _ -.-... 7meT Distance to nearest well_ � �.-.p g -r�-a��_ _Distance f�jm ,foundation.___ ________ C?rstarce to nearest lot lir�e� ------- Nu ber ____.Number of pits--- -----------Lining material__-- -- ------_-_Size: Dia'r eter_2_3...5�.__..___Depth.____ Cesspool: Distance from nearest well----------------- from foundation____--------_-------Lining material----------------------- ________.-_--_ s ❑ I Size Qiameter------------------------------- Depth' ---`- ` '-> ---- Liguid-Capacity E gals. S Privy: Distance from nearest well___._ _.___ ____ ___ _________Distance from nearest'building�` ----------- =. t �.L �❑ Distance to nearest lot line -- --- ---- --------- -------- -------- -- �`,_"- � --------- -rt-- - -•-----.-- ------------- --- ------------ -- `R Remodeling and/or repairing (describe):--------------- _-____--�' ,;'� G' �_.:0-------------------------------•- -----•--------- ----------------------------------------------•-'----------------- -------------------------•------------------------------•-------- ------------------------------------------ --- , l----- ------- 4 ] K I hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, State I s, nd rules _ regulations of the San Joaquin Local Health District. i (Signed) =" Owner and/or Contractor) . -; By: - - Title)----�-- i (Plot plan, showing size of lot anon of system in relation to we- Is, uildings, etc., can be placed on reverse side). V FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By-------- r ---� � -- ----`---- ---- ---------------------- DATE.-------4-�/--- -------------- ---------- -----k------- - F REVIEWED BY------ ------------------------------- - DATE__ i --------=•----------•----f BUILDING ISSUED �...PERMIT �_. --------- ----------------,-�------_---{---'--.........-----------------------1-`- TE-- -------D Alterations and/orrecommendations:�. . --:._.._ __-:' __ -----`----------------------- -- ------------`-x---`------------ `- --------------------------------- ---------------------------------------------------------- , f -------------------------------------- ------- ------------------------------------------------------------------------- ----------------------------------------------------------------------------- ------------ a --------------- --- ------ ----------------------------------------------- ----- - ------- ------- , I I --------------- ------------- --------------------- ------------------ 1 ---------- FINAL INSPECTION BY:__ �.....:____-_ --__ ------------- -`^`----- ;l Date---_--------____ r ,4 SA JOAQUIN LOCAL HEALTH DISTRICT `•,� 7,601 E.Hazelton Ave. �j 300- eaf.0ak Street 124 Sycamore Street s ti205,Wes+9th S+reel �. _ L.,. Stockton,California L. California Manteca, California racy,California