17535 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U E: Q � r z, --- ----------------- 111 --------r-.._ G-v,_---.- APPLICATION FOR "SANITATION PERMIT Permit No. . ------------------ ------------------------- (Complete in Duplicate)----------- µ omplepG - � Date Issued '___._ //A -__.._____________ _____------------------------------ ___ This Permit Expires 1 Year From 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 fwith County Ordinance No. 549. ;y / JOB ADDRESS AND LOCATION.--_f..�7 Jr�- _OP�,FSP----- % Vg 'I' �A��1i''uv Owner's Name----------- —------------- - ----------- -- -------- - e--- -- --- ----- -- - ------ Pon �.� -------------------------------- ' `• r. ^ P Address__ Contractor's Name '" Phone. .... Installation will serve: Residence Apartment House ❑ Comm tial ❑ `frailer Court d Motel ❑ Other ❑ Number of living units:___.11_ Number of.bedrooms __ _ Number of baths -_Zn Lot size ___fC/--,al-- Q-__-_______________________ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table A4 ft. Character of soil to a depth of,3 feet: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam ❑ ay ❑ Adobe ardpan ❑ Previous Application Made: If yes date_-__._--_`.,_..___.l No New Construction: Yes a No ❑ FHA/VA: Yes �o Cl TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Septic nk: Distance from.nearest well-; Distance from ffo/undation_____ __ ______Material_____'_�- r�G r� --1-_`t_a-=---Liquid depth------W-o----------Capacity--- No. of compartments_-_____71�._----__Size.____. - Disposal field: Distance from rynearest well_p,5Q_______Distance from foundation---/__ _ J _,____._.Distance to nearest lot line_,S�__------ Number of line's-----------7Zr-_---------------Length of each line__'�4__'d_77r__.-.Width of trench._c9-- -- ----------------- .Type of filter material____�_��L� C� Depth of filter material___-/X_�______.Total length__---_�50-�_ ____________________ Seepage �t: Distance to. nearest well_.__-L-----____Distance from foundation_-_/Q__1__-_.Distance to nearest lot line__�J__.._ Number of i'ts_j_-'�-------- -Linin material-_____y_ ��5ize: Diameter_____ _—-P___.Depth- Cesspool: Distance fi-om nearest well-'-!:_____________Distance from foundation---------------------Lining material_________________________-_________-. Size: Diameter----------------------- -=- -----------Depth------------------ ---------- ---- ----- -------Liquid Capacity ------ --gals, 1 Privy: Distance from-nearest well.,:: ___:__°._-----------------------_____{-._Distance'.from,nearest building.______-__.___-_-----------__--__-___._. ❑ Distance to nearest lot line---------; = '= ---------------------------- �. -------------— s - -- Remodeling and/or repairing (describQl:---------'--------=---- _ -..------------- ------•------------------------------•• --------------------- '=---------------------------------- = ` ------------------------------------------------------------ ----- ------------------------------ -- R - -____________________________________________________________________________________________________________ ____________________ ___._____-______._________----_______-----_--___-_._-___- - __-- I hereby certify that I have prepared this application and that the work will be done 1n accordance with San Joaquin County ordinances, State h an4 rules regulations of the San Joaquin Local Health Dis+ricf. --------------------------------------------------- ------------- (Signe dl---------------------------------- -- (Owner and/or Contractor) i BY:------------•---••---- ------ ------ -= - - -------------------------------------------------(Title)---- ------------------------- (Plot plan, showing size of lot , ation.of system_in_rela Ean.to:w_ells_buiidings,-etc.,-canrbe laced on reversside). If FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY--- _..r-------------------------------------- DATE------��1 1� ------ ------ ----- - -------- --- ------ r REVIEWEDBY--------- ------------------- -- - -- ------------------------------------------------ SATE---- - --------- -- -•--------------------------•-------- BUILDINGPERMIT ISSUED---------------------------------------------------------------- -- -- ------ DATE--------------------- - qs�- Alterations and/or recomme dations:.__S ( !�P 1-----------I- ------ � 1 ; � � s ��"�` w -------� ._ k.-A ----------- '- .t�--------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ------------------------------------- ----------------------------------------------------------------- ----------------------------- -------------------------------------- -------------- - FINAL INSPECTION BY:....Cy__,__.... ' ' i- '-- Date------ ----------------------------------------- SAN - - ------------------------------------SAN JOAQUIN Q6tAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street '1 - 124-Sycomore Street 205 West 9th Street It Stockton,California Lodi,California s 1. Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CC. Llll ILI J