14158 - Laserfiche WebLink

Home Browse Search

------------------------ APPLICATION FOR SANITATION PWMIT Permit No. ..... ............... =----------- (Complete in Duplicate) Date Issued --- This Permit Expires 1 Year From Date Issued Z(e/^ 0Z.0 w 2x District for a permit to construct and install the ork herein described. Application is hereby made to the San Joaquin Local Health This application is made in compliance with County Ordinance No. 549. r Ap J B ADDRESS AND LOCATION-_U .---- Y " n^ , Phone----------------•--------- r Y �r n Owner's Name.-Mr 1~ �7-\. �� '° --•-------- Address-- ........�-----�`_t _ .j.. �• -- -------- = = --� ' Contractor's Name-----. �� L` �, _IST }........__.l Tl r"?' -•--•-.. Phone---------------------••-•-•------•- Installation will serve: Residence"�Apartmenf House8' Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of liviriq-uni#s:' _ I�umber"of bedrooms _?—Number of aths ..�.... Lot size ____. -•••� -� �`-/ .- Water Supply: Public system l] Co�munity system ❑ Private 0 Depth to Water Table ' ft. Character of soil to a dap+h of 3 feet: Sand ❑ Gravel ❑ Sandy.'Loam Clay Loam ❑� Clay❑ Adobe❑ Hardpan ❑ :. ..:,. ° ] No New"Construction: Yes No FHA/VA: Yes No f r $; Previous Applica#�n Made: (lf yes,date__________________ � ® ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is avaeila Ib within 200 feet.) /C/ 4 e c Tom..._._. Septic Distance from nearest well___�7 Q__.Distal�ce from foundrn_______ ____________Mater' 1... _._ __.~..._____... f+ its' , �( _ _Li uid de th--_-._-- Ca aci / Q• - No.,of compartments_.. r' ize_ � P. --•------- P #Y f :_ r 0--_----Distance to nearest lot li e______________ Disposal Field: Distance from nearest well-_�t .____Diso once fro foundation__.. -- �� Len th of each line...... -_fit_._.Width of trench._-- -; ..----.•...__..... Number of lines__________ --- -•=- g •. /, 'Number ype-of filter mater ial.---� _G► - De th of filter material_.--- --------Total length-------- .--.----•------•---•----.. ..: { . -• ' P F _-_Distance from!foundation....................Distance to nearest lot line.......... Seepage PitDistance to nearest well-------------- i �' '[ ❑ J£•�. of pits__...-------•-•----ca`Linfing material---------•-•--------- .Size: Diameter---------------•-------Depth-------•--•--------•............. Cesspool: Distance from nearest wel _____.._Distance from f dation_-."----------------Lining material---------.-------------......__...._. ❑ Size: Diameter-----• ----------------------- ----Depth------------ ` �; -------Liquid Capacity----------------------------gals, 't % ' PI•ivy:� Distance from nearest well.�_�_-____________________a'_--------------------yDistance from nearest building__-.._.._____.________-.--_----•-------••. Distance to nearest loft line-_.______._---------------------- - ❑' ----------- ------•------- Remodelin and/or repairing describe �� ----•-- -------------------••--•' ` t • .. i 9 P g -� ----------------- :..... ------- -------------------------------- .. --••-•--•----•------------------•-------- , --------------------------- --------- •---------------- I h--e- certify_--that 1 have - re -a--r- +his-a-- lication and that the work will be-done.in•accordan-- ________" ______ __._ Li ordinances, SAlla. , rules and regulations of:ahe San Joaquin�� T.•- - - Y y p p PF ce with San Joaquin CountyLocal Health District. Si ned F - --•------ - ner e r Con ctor) ( g ) ---- ••_------•-- ---- ------ itle) -•-----------------•-----------n - ---------------------- - [Plot plan, sht,` locat of" stem inrr6l' ntto wells, buildings, etc., can be placed on reverse sid`e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �. ! DATE------------ = `� "`T-.--•• ' REVIEWED BY--------------- --------------=--------------- --------------------------------- __.... DATE------------------------ BUILDING PERMIT ISSUED ' , .=-------r -"-•--- '..�:�D�4TE •-- ---------------------------------- --------------- # �iiFi Y it►'+yr1 , �, .........�1-------_— ---------•- Alterations and/or recommendations:----.-•:=---------- ==----- -------•--•-------------•--- ---•--- ------------- . _.._--------•------••---------•---- ----- -•------------------ ---------------- ............................. --_.. _ _ ; - - --- __. �--- FINAL INSPECTION BY .. .. . . ----: � Date_________ _.__..--"_"_.-_--.-. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 91h Street i' Stockton,California Lodi,California Manteca,California Tracy,California E9 9 AEVISEP 8-59 2M 5.951 ATLAS 1