18537 - Laserfiche WebLink

Home Browse Search

F(R OFFICE USE: I ----------------- ` = I �71 �-S--------------------/--= APPLICATION FOR SANITATIONn PERMIT Permit No. ----------------- ------------------------------- (Complete in Duplicate) Date Issued _--------------------------------------------------------- This Permit Expires 1 Year From Date Issued_ Applicatiop 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 with County Ordinance No. 549. ff 3 JOB ADDRESS AND LOCA ON ------------- }- .---------` T Owner's Name--------------- -- - � .Cj7/7.- /_.eJ /1''/ Phone------------------------------------ --- - --- --- 7 Address ---� ----- = �, Contractor's Name-------------`��- --------------------•----------------------- Phone':-- Installation will serve: Residence [j]4Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms __/Iv_. Number of baths _f--- Lot size ------- 0;1_0 --. - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 2-"Clay ❑ Adobe ❑ -lHardpazl ❑ Previous Application Made: (If yes,date---------------- I No ❑f New Construction: Yes �No ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--__-.------Distance from foundation__-f40.__-------Material---- No. of compartments-.----__')'-------------- ---------Liquid depth--.�--.14----------Capacity---BPel--------- Disposal field: Distance from nearestII----.."'..----.Distance from foundation_- ,6. ---.---Distance to nearest lot line--P-0--- --- Number of lines---------- of each line-d?o_`��-_�--.�f'�th of trench---------.:- ---�r_______________ Type of filter material.- a �f�.---___--_-Depth of filter material-lamer..--------Total length.-.-__ f1-_�------------------------ J Seepage Pit: Distance to nearest well-________"----------Distance from foundation.-._3&_"..--.Distance to nearest lot line--.l 4-_`.._. Number of pits-------/-------------Lining material---w0 per-_..Size: Diameter--._- ..`_ -_--Depth....... __'------------- Cesspool: Distance from nearest well------------- ---Distance from foundation....---------------Lining material-...----------------__.------------. ❑ Size: Diameter----- ----- --------------------------Depth-----------------.---------------------------------Liquid Capacity------------ ----gals. Privy: Distance from nearest well------_------------------------------ ---.---.-Distance from nearest building._°-------.._-----_-----_----.----..-_--. ❑ Distance to nearest lot line --------------------------------------------------- ------ ----------------------- Remodeling and/or repairing (describe):_-------- 1�- i�.�#i.-e�-_�_---- ,/_,$'�',/IK�_G-------.- �,..a',?-�i�f---------------------------- ------------------- --------------------------- - - � ------ C � ---------------------- - - -- -- -- ------------------------------------------- ------------------•----------------------------------------------•---------------- ----------------------------------------------------•------------------------------------------------------------------------- ----------------- --- -------------------------------------------------------- I --------- --------------------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws d rules and regulations of the San Joaquin Local Health District. A 1 ' �'-�� C ---------------------------------------- Ow er and/or Contractor) (Signed) -------- ------ ] - Z----- --By '_"�---------------- ' Title = (Plot plan, show'rl�g size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY I APPLICATION ACCEPTED -------- ----------------------------------- ----------------------- DATE--- ----- ---- - REVIEWEDBY-------------------- - ------------- -- --------------; - ------------- -------- ------------- DATE------------------------------------------------- BUILDING PERMIT ISSUED----------------------- f �: - -- DATE--------------------------------------------------k____ and/o[r ecommendations:.-.-..__--.`f V -_.___._.-----ria s-:.___ �'-`dam` -------------- Alterations —�� - ..��` _ ,(� �+ p �• -- ------ + -�--`1-----------=-_� r` � -7t-t �� fC� dd ------------------------------------------ ----------------------------------------------------- -------------------------------- ----------------------------------------- ---------- -----------------------------------------------------'---------------- .................................................--------- ---'---------- ---_---.------------------------------- ;r----------------------------------- 44 FINAL INSPECTION BY---- ----------------- - -------•--- ----------- Date---- ----- —' � � f' ---------- --------------------------- SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E,Fiaselton Ave. 300 West Oak Street 124 Sycamore Street 203 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C Q.