14216 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE - -----------------•-----------------------------------:--- --------------------If... APPLICATION FOR SANITATION PERMIT Permit No. ..... ... t ---------------------•------- ---------------------- (Complete in Duplicate) ' -------------------------------------._.. This Permit Expires I Year From Date Issued Dote issued Application is hereby made 'fo the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in nom Mance with County Ordinance No. 549. :3V 3s Z Cot e� JOB ADDRESS AND� Owner'sName ! q 10.1!e. /r-.__--- -------•----•-------•-------•------------•---------------•-•----------------- Phone.................................... Address------------------ ..A,0n......... t .e7ar................ -- --- ----------- --------------------------------------------- --------------- -- Contractor's Name--- ... Phone................................... i Installation will serve: Residence Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livings`: ______ Number of bedrooms _ unit _� ,3---. Number of baths -1---- Lot size ---�_�"_�-�..-"�f----•---........................... Water Supply: Public systel� ❑ Community`system C] Private ® Depth to Water Table(�r _ ft. Character of soil to a depthiof 3 feet: Sand ❑ Gravel ❑ ..-Sandy Loam ❑ Clay Loam ED Clay ❑ Adobe❑ Hardpan jo Previous Application Made:[[If yes,date____________________) No k] New Construction: Yes k] No ❑ FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . r - .. . r - . (No septic tank or cesspool permitted if public sewer is available within 200 feet.).�} D' S�+ptic Tank: Distance from nearest well__ _._a_-__:_._Distance from foundation.f.._..._.__.�.Material... ............................................. No.`of tom artments-._2-_ Size_ !-►- ___¢ S L. �] :I P -------- -------Liquid:depth- ---------------Capacity.,..... i Disposal Field: Distance,from nearest well.-X'��--------Distance from founclation._ b______-___-Distance to nearest lot line---:......... (� ` NumberA�o��f lines------- _______________ ___Length of each line__�__�_:�---------------Width of trench___X-9_.__.________.......... Type of�'tilter material. ____Depth of filter materiel__, ----------Total length..Orp........._____________________ Seepage Pit: Distance to nearest well-----_____ -Distance f om undation....1A .........Distance to nearest lot line----!r-------- Numbed if pits...-_______________Lining material.. ___.-size: Diameter-_._ _s......_..:Depth-__2477---------------- Cesspool: Distance. from nearest well from`foundation---------------------Lining material------------------------- ........... o P _ ❑ Size: Diameter--------------------------------------Depth-=--------_ ------�� =�T-�-------Liquid Capacity--------------------------gals. ❑ Ili ---------�----------------------Distance from nearest building---'------------------------------------- I Priv Distance' from nearest well-------------------------- � m Y� Distance to nearest lot line ------•---•--------------•----------------------------------------- Remodeling and/or repairing (describe):-------_1111____--------------------- L I --------•1111------•1111----------------------�p-----------------...----------------------------------------1111-- ------ - ----------------1111--------•----------------------------------------------------------•-1111-- `Ih ' ► 111 ----- ----------- ---------- --------------------------------------••--••-••-----••-----•...._......I----------------------- �p -- . ----- •--------------------------1111.1111-- --------------••------•----------------------------------------------------------------------------------------------•-------,....----------....__...---------•------------1111-- , hereby certify that I leve prepared this application and that the work will be done`in accordance with San Joaquin County ordinances, State aws, and" ufes and re ulafi n San Joaquin Local Health District. 4� r. i a l� -------------------------------•----------------------------.......-Owner and/or Contractor (Signed).y------- ---- --------------•---IE--------------...-- --------�----._. ...----------1111----•-------------•-•1111...1111--••---1111-( } .. . - • ---�--•- ' ) ,[ B : ------------------- ------------- . Title---• -• _ •_ (Plot plan, showing site of lot, location of system in relation fo.wells, buildings, etc., can be placed on reverse side). yip 0. Ar FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDI y --------------------=--------- I DATE4 - �� '7s - ----------------- REVIEWEDBY--------------- -------i -------- ----=-- ----- --------------------------- ------•--------------------- DATE---------------------------- BUILDING PERMIT ISSUED'(............... -----••------•---------•------------•--------------------------------- DATE------------------------------------------------------------- Alterations and/or recommend'afions________________ ' ------------------------------------•-----1-----------------•1111--•1111---•--1111-• •--------•---•-•--••-----....--•---1111--...-....-1111----•-- --•--------------------------------•--••------ -(---•------•----- -- -•-- ---------- -------- ----------••-------------------------•----------- -------•---------_-----------------------------------------------------------------•_....-•---1111---....---------_.....-•--••-- -----------------------------------------------!11----------------------•-- ------------------------------- -- -------....------ --•--------------------------------------------------••--------•------------------- s � -- - -------------------------1111-- --- Date------- FINAL INSPECTION BY-r : ----------------- y. SAN JOAQUI CAL HEALTH DISTRICT 130 South American Street300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i _ E6 51 REVISED B•59 eM 5-61 ATLAS