16149 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: " ---------------------------------------------- --------- ------------ ---'--- APPLICATIQN FOR "SANITATION PERMIT Permit No. -- --------- ------------------------------------ �M '�. y"`' jCompleteinDuplic�ate)_t ---------------------------- p " j.Tl is Perm iflExpires 1 Year From Date Issued E 'Date.Issued .____:_______ (P Application is hereby made o the San..Joacluln LocaliHealth District for a permit to construct and install the w r erein descn d. This application is made In compliance : lth County 4 dinance No. 544. IIE• � „ ) JOB ADDRESS AND LOCATION _ 1` '_ ------------ `O------ __----------•--- - , d ---------- ------ :Ow ----- / Owner's Name = - -------•- -------- Phone--------------------•--•-------- --------- - - - --------- - -------------------------- Address__.. _ _. --------- -- --- -• ---------- -,r----- --------------------------------------------------------------- Contractor's Name---------- I .•---- -- ______________ Phone-------------------................ Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unitA ______,Number of bedrooms _3 Number f baths __� t size __-_____, =_l` r./Zf.GE�________________ _ I . Water Supply. Public system Community system Frivate De th to Water Table ________ ft. o i PP Y� Y 11.1 I ❑ Y Y ❑ � p Character of soil to a depth f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loarrt ❑;- Clay ❑ Adobe [❑ Hardpan, Previous Application Made: li�llf yes,date------------------- No � New Construcfion: Yes 11�4 No ❑ FHA/VA: Yes ❑ No ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted:if public sewer is available-within 200 feet.)-A--- �.-- SepticlTank- Distance from nearest well--.5-6----Distance from foundation----I_p---------Material------____ _ _ _ 1 No. of c mpartments__._ -------------`-Size_.T----- d _S-_Liquid dep 6h--- Capacity- ap�V Dis os IrField: Distance from nearest well___ d._.._Distance from foundatio ____-/_ -------Distance to nearest lot line.. -- Number of lines--------- Len th of each line______. �G_-r____.__ Width of trench.___ " �_� 9 ,� .---------- t �• Type of filter material- _!�_Depth of filter material_____111-.____.__-Total length__. - '_ ______________________ Seep ` Pit: Distance to nearest well C?_*-_____pistance from foundation_____ .____.Distance to nearest lot lirle____��_.___._ ( Number: f pits-_-- ____Lining material_ Size: Diameter____ De th__ _ �' i Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---.--------------------------- ..-_.. Size: Diameter---------------------- ---------------De th---•------------------------- ------Li Liquid Capacity ❑ � p -- -- 9 --------------------------.'.gals. Privy. i . Distancelfrom.nearest well ---------------------------------Distance from. nearest building___._...________-_____________._-._-.__ ❑ Distance to nearest lot line-- ------- ----`------------------------------------------------------- ------------- - t - t T Remodeling and/or repairing (describe)------------------- ---------------------------------I----------------------------------•--------- -------------- -•- r .ij ------------------------------------- ---------------------------------------------------------------------------------------------------------- ----------- -----------------------------=--- ------ :I� - . ---------------------------------------------•--:--------------------------------------------•---------------------------------------------------------'--------------------------------------------------------------------- I hereby certify that 1 1'.ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statglaw and rules and regulations of the San_Joa quip Local•Health District. L(Signed)-------- ------ - ='"f -------- _---- i------------------------------------------------------------- :: �.Ow.uer-end/or Contractor) mil fir - -----•---- - . ---------- -(Title)_ --------------- ------ _ Y•---------- - - ------ - = (Plot plan, showing size of lot, location`of` ys+em'in at-on, tolwells, buildings, etc:,'can be'.placed on reverse side). -�' i ��. FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------------- DATE = ---- -----------------------: REVIEWED BY -- -----------�N---------------�--- ----------------- -----------------------------`-- DATE--- BUILDING PERMIT ISSUED-SII----------------- ------•----------- ----------------- DATE--------_------------------------------------------ " Alterations and/or recomme I�dations:- ------ ----------------------------------------------------------------------- ----•---------------•--------------------------•--------- . .i � - ------------------------------------- --------- --------- ----- -- t �� # • ---- �----------- I t -------------------------------•------------- ----------------------------------------------------------------- --- --------M-------------------)-------- -------- --------------•------- FINAL INSPECTION BY:- - ---- --------- `SAN JOAQUIN LOCACHEALTH-DISTRICT t 1601 E.Hazelton Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton California Lodi,California Manteca,California , Tracy,California i E6 9 REVISED 8-59 31A 3-'63 F.P.CO. i