13164 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- - Ffi mit No. -------------------:-------------------------- APPLICATION FOR SANITATION PERMIT Per ----------------- ---------------------- (Complete in Duplicate) Date Issued --- ._-/f- -•• / ------- --------- --------------------------------------- This Permit Expires 1 year From Date Issued L -------- ----------------------- ------------- and install the work herein described. Applica�tion is hereby made to the San Joaquin Local Health District for a. permit to construct This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.___-3.0/0------- % ---------------------------------------------------------- ---- Phone------------------------------------ Owner's Name-----------` ame------------ ------------------------------------------------------------------------- Address-----------/P/4' .r_-.ITS - Address-----------/P/4/7 ----------------------------------------------------------------------- Phone----------------------------------- Contractor's Name_--:-------- Installation will serve: Residence.�Apartmenf House C3 Commercial E] Trailer Court 0 Motel [I Other El Number of living units: _--/__ Number of bedrooms S--- Number of baths Lot size ZC11y,/1y1&--------------------------- 4- Water Supply: Public system E] Community system [�?�Ivate E3 Depth to Water Table loerrt. f I Clay 0 Adobe 930"Rardpan 0 Loam E] Clay Loam [I Character of soil to a depth of 3 feet: !Sand E] Gravel E] Sandy Lo PHA/VA: Yes PR-- NO 0 Previous Application Made- (If yes,dcite---------- ---------I No � New,Construction: Yes U�—No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e ation--- g�9--------Materiai__e�_e, --------- Septic Tank: Distance from nearest Y41-----!�------Distance from found or Capacity. a%2------.•- No. of compartments------ ...Sjzer,"___X W"_.-Liquid depth--- ----- arl", . ......... i __V .1...... --- f �C>61 Field: Distance from neares well......—------Distance from foundafion._1/1�9--- Distance to nearest I-qt line Disp each line----- ...............Width of trench.-- OZ_.-"-/------------=--------- Number of lines--------------A- --- -- -----------Length of Is Type of filter rn�. A-jj4e--Depth of filter material--/ ---------Total length--/..029_:------•------• _ ,- t .--------------+ at", nearest lot line-$----------- Seepage Pit; Distance to nearest well-----=7:77�-------Distance from found n- ------Distance to Number of pits-----19-----------Lining M-aterial./e 0 4�e ----S2-- ---------Depth"-. _- 1%r- ------Size: Diameter lest well ."---_-".._:Distance from foundation------------------- Lining-niateriai---:---------------------------------- Cesspool: Distance f�orn near ---- ---------_Depth- ----------------------------------------------------Liquid Capacity----------------------------ga Size: Diameter------ --------------- 4 'Distance from nearest building------------------------------------------ Privy:: Distance from nearest well-------------------------------------------------- 'lot I� ------------- -------- _.� Remodeling -.1........ -------------------- - El Distance to nearest line----------------------------------------------- ------------- --_---------------- scribe):------------- -, _e / - - .- Remodeling and/or repairing [describe):----__--__----- --- ---------------------------- ------------I------------------------------------------------------------------------------------------ ------------------I -------------------------------- ----------------------...... ------------- --------- -------_-------------_- ----------------- ------------------------- --------------------------------------------------------l----------i----------------------- --I-----------------------•--- ---------------------------- -------------------------------------- ---------------------------------------------------------------------------------- ---------------------------------- ------------------------------I----- th' work will be,done1ri accordance with'San Joaquin County- lihereby certify that I have prepared this application and that e ordinances. State laws, and rules and regulations of the San Joaquin Local i HealthDistrid. (Signed)..---------------il--------- - ------- ------------------------I =wFr �ontractorj -------------------------1'�!7lm-------- --------------------- i. ---------- fie)- IT ........... ----------- - -------- ----------------------------------- - --- ca.------------------------- i' lafion to wells, buildings, etc., can be placed on reverse! side). tPlot plan, showing size of lot, location of system FOR DEPARTMENT USE_Q t APPLICATION ACCEPTED By....'_ ....... DATE..----`)------------ ----------r---- DATE--------------------- ------------------- ------------------ REVIEWEDBY--------------- ------ ----------- ----------------------------- ------------------------- DATE------------- ----------------------- lafion ��EPART� APPLICATION ACCEPTED BY-___. IT ISSUED---------------------------------------------------------- ------------ ----------------------;7------ BUILDING PERM ----------------- ---------- ---- ------------ --------------- Alterations and/or recommendations----------------==------------ ----- - ------------------ ---------- ------------ . ....... . ---------- ----- ------- - --------------- ---------- ------------------ --- -- -- --------, ----------------- ---- --- - ------ ----- - ------ - - ------- ----- -------------- ------------------------------------------- - ------------- ...... ........ ---- - -------------- ... -------------------------------------- ------------ ---------------7 ------------------- ---------- ------------ -------------------------- --- ---- ----------------- --------- --------------------------------- FINAL 1NSPECT]ION'_BY:_._*'--l!�' Date--- :Er Z A SAN JOAQUIN LOCA KH�EAILTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California: Lodi,California Manteca,California Tracy,California • A . E9.9 REVISED a-59 F.P.CD.ZM 6:6;101