17210 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 3 ' 5 r .<� ------------------ Permit No. :..-•-•- t � APPLICATION R SANITATION PERMIT ______ ______ __ __ (Complete in Duplicate) Date Issued ._-�`�--"=:=-.�--•�� --------------------------------------------- - ----- This Permit Expires I Year From Date issued A` plication is hereby made to the San Joaquin Local Health "DiNoc for 9.a permit to construct and install the work herein described. This application is made in compliance with County Ordinance ijf/. .� JOB ADDRESS AND LOCATION.......... " I// -,y--- -•-----�---- A A."d"A-`rn--------------------------- Phone. Owner's Name------------A•Ad-•-�S•7-P•--..__...."_J/•�. .............................. _-?� L Address = t. ✓ vC�' - - --- -• - ----..."..-----•--_..... Phone..------•--- Contractor's Name------------------ •• railer CourtMotel ❑ Other ❑ Installation will serve: Residence Qj jApartment House ❑ Commercial ❑ Number of living units: _J-._"_ Number of bedrooms�---_ Number of baths _.r.."_ Lot size .___""".E��--l�---- � � ��""'" ' Water Su Public system ❑ Community system �• Private ❑ Depth'to Water Table -------- ft. Supply: Y Adobeik Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ _ Clay❑FHA/VA. Yes ❑ No ❑ _ New,Construction: Yes ❑ No ❑ i ) No, Previous Application Made:. (if yes,date"- t: TYPE OF INSTALLATION AND SPECIFICATIONS: (Nn septic tank or cesspool permitted if public sewer is available within 200 feet.) ,p N� Septic T$nk: Distance from nearest well------ from foundation__-__.Ld--•---.MaterlaL------1_�/capacity � , P _1* Li uid dep. P tY .. ^� a th""----------- ------------Ca as . -�----------Size------- - •-- •- No. of compartments------- - pis osalrFf id: Distance from nearest well_---`n------Distance from foundation__".L_" _..__.--W dthcofttre nearest lot line__s.S__-..-.-_- p Length of each kine-----•=7�`- ------;w '� ❑� Number of lines-----------�+------- g Total length----•-----f"4 4••-----fir Type of filter materiaLZAr Depth of filter material_---.--�-7 -` 5epage Pf: ` Distance to nearest well-__,----__-�_----Distance from foundation".._..�- -----•-.Distance t-- nearest lot kine__-till.""_.._--.- Number of pits---____-- Lining,material--"-AQQ G/K-- --Size: Diameter------ -•------•Depth"-.---.." • I� -! gals. ' Lining material from foundation-".-_"______________ .."-"""..__._Liquid Capacity..-----•------•-."."...----g_".__",..__".."...------ Cesspool: Distance from nearest well-----------.: . -----;`.De th------------------------------------ -------------•- • ❑ Size: Diameter----------------------------- �3 p _.. Distance from nearest well""-__".."""__:_--------------" Distance from nearest building."___-- ","__ Privy: r' ❑ Distance to nearest lot ine--------------------------------------- --- - l Remodeling and/or repairing (describe --------------------------- ------ --•"-----••-----•--- ------------------------------------------------------------------------ ••----------- -----------•----•--------- - - - - - ------------- _--••-----•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County . I ordinances, State laws, and4rulesangulations of the SanJoaquin Local Health District. ----- ner an r Contrac- .-(Ow d/o ------ raleBy:-------------- -------- ------------ -------------- 1 l (talo+ plan, showing size of lot, location 04 system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - ---ISS-------------------------- - DATE----------- / ". - ---------- ------ APPLICATIONACCEPTED BY------------- ------------- DATE--------------- -------- ------------------------•--------- t' REVIEWED BY----------------------- ----••------------- --- ------------------------ " "."" DATE....---------------------------------------•---------------- t BUILDING PERMIT ISSUED--------••-----•----- ----------------------------------------- � ."...L� ----•-----••--------•-•------•-------•--------------- i Alterations and/or recommehddtions:-_:h-`-X`? ` �� --••--•---•--""-•-----•_________________________""._-_- •-•----•--------•--•------- ........:..........----------- -- -------------- -------------------------- Date"".,., "..--•---- ---- FINAL INSPECTION BY:--"4040_ SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Streit 300 West Oak Street ?racy,California 130 South American Stnet Manteca,Caiifornia Lodi,California Stockton,Californta �°^ J E8 9.0EVISSo S-99 2M 5-61 ATLAS E.