Laserfiche WebLink
FOR-0 FME USE------------ <br /> - - --- - <br /> J`97 <br /> -- - ------- -- - - <br /> .. . ..... <br /> .. <br /> ---------------- <br /> ------- ----------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No.(Complete in Duplicate) <br /> --------------I--- ------- -- ---------------------------- <br /> - ----- ---------------------------- ----------------------­ I This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and in all t work herein described, <br /> County Ordinance No. 549. <br /> This application is made in cam I' to P_0 <br /> p Iia e with <br /> 01,1v� <br /> 'Z_A; -4 <br /> - - - L&--- ----co-R-1111(sir <br /> JOB ADDRESTA 10 lmR.._--ia <br /> Owner's Name_� -0 - ------- -------------------------------- Phone._4& <br /> --- - ---- ---- ------- <br /> Acldress------------- x --- --------- - -------------------------------------------------------------------- ----- <br /> -------- -- - 4k - - ----- -- ----------- ----------------- Phone- <br /> Contractor's Naml_::��, _ <br /> Installation will serve: Residence Apartmen . House E] Commercial E] Trailer Court -E] Motel E] Other E] <br /> Number of living units: Nu ber of,bedrqom!.A--- Number of baths J _Lot size --------- ------/0-0------------ <br /> Water Supply: Public system E] Community system &111,10FIrivate, E] Depth-toWater Table "la ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam R?�lay Loam M Clay ❑ Adobe [-] Hardpan C] <br /> Previous Application Made: (if yes,date_...-______________] N_P_e New Construction: Yes FHA/VA: Yes MNo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> Norse or cesspqol permitted if ;6_11 sewer is,availa6le within 200 feet.) <br /> P <br /> V 01 <br /> Distance from s '6-efro /0 ---------------- <br /> Septic Tank nearest well-I Distanc _ �pn--------------------M.91 ia---- ------ <br /> :r, 6--Licluid depjh -4-1 -- - --------- <br /> W', ' N9. of,'�6mpartments-.-Z.- u', e <br /> sa I PeH: ti�tgnce from le <br /> Disposal (LOZ'Co7:��DisfanFe from foundation------------------Distance'to nearest lot line <br /> f-______-.___. <br /> we -------------- <br /> Number of lines--------- Lengt! of each line* ------9.<.:3Wdth of french---,. <br /> --- ------ -i------ <br /> I _Oepth" of filter ---------..Total length_________________________-r__[� <br /> Seepage <br /> filter mafbf r material... <br /> Seepage Pit: ,bistadce to nearest well-----------------71)i'stag'te from foundafion--------------------Distance to nearest lot line_________________ <br /> ❑ dumber <br /> ine----------------- <br /> dumber of pits----------------------Lining material-----------------------Size: Diameter------------- --- ----Depfh-------------r---------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- -------- Lining material_-----__________________-_____-______ <br /> Size: Diameter--------------------------------------De th-..-------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest buil&ng--------------------------------------------- <br /> ElDistance to nearest lot 1-ine----------------------------•----------- ------__-------------------------------------------------------------------------------------------OE. <br /> Remodeling and/or repairing (describe):--------------------- ---------- ----- ----------------------------------------------------------------- <br /> ------------------------------------------------ <br /> -- -r <br /> ---­-----------­--------------------------------------------4------------------------------------------------------------- ---------------------------------------- ------------ --------------------------- ----------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------- <br /> ---------------------------------- --- ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ - ------ -:-- <br /> I hereby certify that I)have prepared this applica ion and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat g-la rules <br /> d win Loc ealth District. <br /> .pys, an rules and regulations of e San Joaquin <br /> 1117 � <br /> (Signed)------------ <br /> Signed)- -----------A117--------- --- --- ------------------ -------------- - -n � or Contractor( <br /> By:-------------------------------------------------------------------------------- ----- -------- ­--- ---(Title)------------------ ------r--- - ---------------- --------------- <br /> r -w <br /> etc.,;' <br /> �f lo" Ioca`ti* u <br /> ,5— rel 1 Aow -on--reverse-side)- <br /> (Plot plan, showing size t �Y_ster� in—ii�— —ells-7b building-' etc.,"t --b placed <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -- ---- -- ---- ---------- ---------------------------------------------- DATE--------3----1;? ------------------ <br /> I REVIEWED BY------- <br /> ----- -------------------------------- ----------------------------------------- -------------•------------------------ <br /> *------------------------ DATE-------------------------=-------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------- ------------------------------------------------------------------- DATE--------------------------------------------- --------------- <br /> Alterations and/or recommendations:--- --- ------ --- ---: - -------- -----------:--------------------------------------------------------------------------------1-T----------------------------- <br /> ---------------------- - ------- ----------------- ------------------------ ------- --- ------------------ ---------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------- ------- ------------- ----------------------I ---------------------------------- <br /> ------ -------------------------------------------------- ------------ -------------------------------------- <br /> ------------------------------------------------------------------------------- --- ------ -------- - ------- I---------- ------ -------- ----------------- <br /> A/- <br /> FINAL INSPECL'ION BY:-.' --- ---- -- -.1-r.........65 <br /> Date---------------- --------------------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hosellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.O. <br />