21977 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ! ` • - ------------------------------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. _6Z_ ` -------------- ------------------------------.- --------- (Complete-in Duplicate) Date Issued - - � __...........................:..-------..----.---- This Permit-Expires i Year From Date Issued f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION = - - l S y�---- 1 ' .I- Q ... Owner's Name u --------- RT-H------------------------------- Phone-----------=------------------------ tiAddress `�I 7 s �� ----------=---- -----•--------•------------------------------.......-----------•------------------------ Contractor's Name----6_W&F___K---------•----------- ------------------------•- -------- ------ - ------• -. Phone------ -------------------........ t Installation will serve: Residence [�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .].....JNumber of bedrooms .Number of baths-__�... Lot size -...9', . _J:5..0... ................. i Water Supply: Public system ❑ Communitysystem ❑ Private Depth to Water Table � ft to Charact1 usR� � py Previous on Made- If of 3es(date_. nd �Grave�❑ Sandy ew Construction: Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ F i pp ( y i� ) [ n: Yes ®�o ❑ FHA/VA: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted:if public sewer is available-within-200 feet:) T l l } Septic nk- Distance from nearest well_.._-5D----Distant from foundation--------/-1�.._. Ma terial -.CQN___C- -1 T _ p No. of tom artments..._ -- _________Size---��_J_O-.X-5--Liquid depth___ — Capacity.-Ig_s-0 i Disposal Field: Distance from nearest well__ ._.Distance from foundation.-.-.-/Q-------Distance to nearest lot line....... [� Number of lines..-..--__-f ...... .........Length of each line_ 10,0...... Width of trench....2.V_1(.......-.....�.-.- Type of filter rtlateriat-.._-l30C;,-.- Depth of filter material /-T. length---------------------f-0-�7--------. # 'IZI Seepage Pit: Distance to nearest well...............______Distance from foundation---------- ------.Distance to nearest lot line--.-------------- El Number of pits— ------------------Lining material--- '-- ' -. ..Size: Diameter----------------------Depth- -------- ------------------UA I Cesspool: Distance from nearest well ----------------Distance from foundation_________________ __Lining material....-..------------------------------ ❑ Size: Diameter.'I ---- ----- -- --- - ----- ----Depth----- ----------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest welt____________________-------------_.----------_..Distance from nearest building-------_--_-.--------------__---..._..--- ❑ Distance to nearest lot line ---------_ - ---------- ----- - ---- -------------------------------------------------------------------------------- --- Remodeling and/or repairing (desJbe):--------- ----- --- =------------ --- --- -------------------------------- ------------------- - ------------------------------------------------------ ----------------- -------------------------------------------------- --------------------------------- --------------------•------------------------ -------------- ----------------- -------------------- -------------- ---------------------------------------------------------------------------- ------------- --------------------------------------- -•------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances, State laws, and rules arid regulations of the San Joaquin Local Health District. f I t f Signed)--- - t-: z-------`------------------------------ -- -----(Owner and/or Contractor) if Irr _ B f -- (Title) ' ' - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----1 t--K --------------- ------------ DATE------ -- ------------------------------- -- -- -- --------------- EREVIEWEQ BY :.."---------------------------------------------------- ---------------- DATE-------- ---- BUILDING PERMIT ISSUED------------- ------------------------------------------------------ ---------------------:----------- DATE-- Alterations and/or recommendations:.---- ----- -------- -- ------------------ -------------------------------------------------------------------- ----------- ------------ ---------------- 1 I----------- - --- - -- ----------------------------------------I----------------------- --------- ----------------------------------- ....... r FINAL INSPECTO�BY 1 � Date SAN JOAQUIN LOCAL HEALTH DISTRICT f 1401 E.Hasellon Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9.2M 1-67 Vanguard Press { i