19296 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: J If s` ` ------------V:_ 6 o APPLICATION FOR SANITATION PERMIT Permit No. __1g �..`... - -- --L--� --------z' Duplicate)liete in om lcate C -----'-�-- - � -�--�--- � - - � P P� ) � bate Issued ------- -- -- - - - ' Thi•Permit Expires_1 Year From Date Issued Application is herebymade 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. S49. l( - t JOB ADDRESS AND LOCAT ON /A�g[��f ---- --------------------------•--- --------•---------••----•-- ----------------------- _ --- -- -----------)- r.._ E rlb Owner's Name + i �� ------- - ------------- - - --------- Phone `} � -3-- --------- .-f--------- . Address-----------------•-- - -- ----------•-----------•--------•-------..._-------- ------- ----- Contractor's Name-----=----------- -----�' ------- --L _ _�__ _ _ __ - Phone--------------•----------- 1 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer CourtI]� E]Motel Other I ❑ Number of living units: ____ Number of bedrooms __Number of baths _:_�__ Lot sii6 _______ _ __ {-� j---- _____________ Water Supply:. Public:system Community system ❑ Private ❑ Depth to Water Table i_-'t_ ft i Character of sail to a depth of 3 feet: Sand J] Gravel-0 Sandy Loam ❑ Clay Loam ❑ ;Clay._ Adobe Hardpan ❑ }` Previous Application Made: (If yes,date--- J No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �` f (No septic tan Cor.cesspool permitted,if;pub lic-sewer-is available-within 200-feet:) p �� 4No of compartments ----=---ation----------------- .Material-------- -------------------------------------- Se tic T Distance from nearest well_______________ _Distance from oun s� P f Distance from found Liquid-de�th_________-___-.-.___-_-_Capacity------------_________�` Dis o Field 1 p - Distance from nearest w II ation��l1_ ti Distance to nearest !ot fine___,��_.._.. ' K Number of lines__--__--_---7 .- Length of each.line___-_---__r�-_-'4-___-_ Width of trey _-v._______ . r , „4 q�_ c 1 f F' Type of fitter material__o, ,ee, i Depth of filter material--- , Tota€ length ^__ _------=tom______/-- 1 ' . Seepage it: Distance; to nearest//well______________--------Distant fr m fou ation___-V710 __.Distan��.to nearest lot lint_. __-_- ®� Number of pits-----1_f"""'� Linmg mmaterial _� - Size: Diameier p >_ __ De th- Cesspool: Distance from nearest;ell- -.{ _____Distance from foundation-_-------I_-- ---_Lining material--------------------------_____-_-__. Z El N, Size: Diameter------- J__-t- '' �`----------Depth---------- -------------------------------- --------Liquid Capacity------------------------ ga€s. Privy: Dlstance.from nearest well;,---- --------$------------------------------_Distance from nearest building-�-------•------------------------------- ❑ i Distance to+nearest'lot line_----- -----------------------------------------=--------.--------------- ------------------------------------------ Remodeling and/or repairin9T(describe)_______________________ S i _AAA ( � --__-__--•--•-•------------------------- ------------------- --------•-----•------------ --------- ------ --------------------------------------------- - ------------------------------------------ -------------------- -- ---- __________________-_______-_—_--_________-________a____y___._- -_.._._____.______ ______________.___ _____---------__ _ ____ ______--__---_________--____ __ __________.___________-_____--___._ i•, � ---------------' { .� -- � I I hereby certify-thaf I havepre'pated Mis app'lic`ation andTthat the work willT a 'done in accordance with San Joaquin County ordinances, State laws and rules and ie.4ulations of a San Joaquin Local•`Health District. (Signed)------ ---- -- t r------ - --- ------ = - --------------------------- --------------------- ----(Owner and/or Contractor) v iTt 1 fr-�=� - --- [ i ------------•------------ __Title s (Plot plan, showing size of,lot,.location of,sysfemYin,relation to wells,'buildings, etc., can be'placed on reverse side). .. FOR DEPARTMENT U E'ONL APPLICATION ACCEPTED BY----- ^-" -- --- --�� DATE - - - -------- -- -�------ -- ��}- --�------ - REVIEWEDBY--------------------- -------------------- ----------------------------------------------- ----- ------------------- DATE------- �_. ---�--I---- ---------t._..- ------•----- - -- ----------------- DACE-- ----- ------ ------------------`-------- --- ._. Alterations and/or recommendations;------.- BUILDING PERMIT ISSUED-------------- ---- ----------------------------- 1 --5-- moi----- x Y� .� r'i �.'[ —r +_C f –e f a—c� t e' C f ------- ----------------------------------------------------------- ------ -----,----------------------------------------------------------------------------------------------------------------------------- --------------------------------- ---- ----- -- - ----------- -------- --------- •--------- ---------•-------- ------------------------------------------------------------------ FINAL INSPECTION BY: /(_`//; Date- -- ---_`` - --- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1401 E.Naxellon Are. 300 West Oak Street 124 Sycamore Street 205 West 9H,Street t f Stockton,California lad!,California y Manteca,California Tracy,California -a4x ES.-9 REVI5 Efl 5-59 3M 3•'63 F.F,120. / 1