20373 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------- APPLICATION FOR SANITATION PERMIT Permit No. _�]� 33 --------------------------------------------- ___________ _ ._ ___ --------------------------------------------------------- (Complete in Duplicate) ----_ - This Permit Expires l Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN TION. ' /� r-1AII�`� ,-�� _S - ----- Owner's Name------------7--------(�_�_!�_ ,C? � �/�fl.L...-L-/ti'C-�.S----.�----: .��--s�Fhone- --------------- ----------------- Address----------------�-�- �/J••-�� ° f��-rc�------- ---------------------------•---..-..------------ Contractor's Name-----�---/ `-=_- /"¢1 ✓. �._- ��/S___ v ___._- Installation will serve: Residence [21/impartment House ❑ Commercial E] Trailer Court E] Motel E] Other ❑ f AA I- Number of living units: _-L--- Number of bedrooms _. Number of baths _- __ Lot size / _. .T --_-___��---_-_ Water Supply: Public system E. mmu Conity ❑ ❑system rPrivate Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date....................) No [[ New Construction: Yes ❑ No D�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - °-------Distance from foundation--. --- Septic Tank: Distance from nearest well______ 1 -----.-.Merial__..- -5_/ __...---- No. of compartments-------- cam'" -- - L - Liquidi - -- / - . -......Capacity-- w ------ Disposal 1 Field: Distance from nearest well....'-�.-----.Distance from foundation-----�Q�-.�-..Distance to nearest lot line-�T.__ --- N [� Number of lines-------- ^0. -. ------------Length of each line__Gd-3p-:------.Width of trench--- }-'`----------------- Type of filter material. . Depth of filter material_.2 `�------.-Total _-�.�u2�1___-- .__-_------ �� I Seepage Pit: Distance to nearest well-------._------------Distance fro foundation_--_ - -_-. ce to nearest lot line-- _--f---_ 1A Number of pits----------------------Lining material__��/('Size: Diameter-- p . i / .Y--- De tn__D2--7__f------------- Cesspool: Distance from nearest well--------- ------Distance from fou undation-------- .........Lining material----___--_..__--.-..----..--.--------. Size: Diameter-----------------------``---------- ----De th-------------------------------------------- ----Li uid Capacity gals. t ❑ p q p Y Privy: Distance Prem nearest we]...'.---______.__.__----------------------....Distance from nearest building------------------------------------------ �- ❑ Distance tornearest lot line-------,s'------------ ----- --------------------------- -------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe}: �E- 5_'__ .r _-- .---------- t a r- I F IL ---------------------------------------------s------__-____---_______-------_-_-_-_-------._ I hereby certify that I have prepared this application and that the wor ill be done in accordance with San Joaquin County ordinances, State laws, and rules and'ire ulations of the San Joaquin ca Health District: 's (Signed) -- -��-- -------- - .S.�L` C /1-------------- -- c- .-.Owner a /or Contractor) } By:.------ ----- ----- {Title) j (Plot plan, showing size of lot, locatiof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I 1 APPLICATION ACCEPTED BY-------------------- --------------------------------------------e_11------ DATE--------- -- —------------------------ l REVIEWED BY DATE------------------------------------------------------------ BUILDING PERMIT ISSUED _f i = /7 DATE---------------------------- -------------------------------- Alterations and/or recommendations:------ � --------�� --- --R---.......---------•-------------------------------------------------- - --------------------------------------------------- ------ ----------------------- ----------------------------------------------- ------------------•--- ---•--•---•---------------------------------------------------- --------------------------------------------------------------------- -' -- ----- - - ---t'------��1 - -------------------------------------------- ------------------------------------------------------------------- ------------------------------------ ---------------- ----------------------------------------------------------------------------------------- ------------------------------------------------------------------------- FINAL INSPECTION BY:------. � - Date------ -------------- ----- - ' SAN JOAQUIN LOCAL HEALTH-DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Stockton,California Lodi,California Manteca,California Tracy,California r.P.co.