19580 - Laserfiche WebLink

Home Browse Search

�R OFFICE USE: T— ---------------------------------- --------- ------------------------------------ --- APPLICATION FOR SANITArTIOW PERMIT Permit No. ---------- ----------- , (Complete in Duplicate) Date Issued --------.-.---- --------______-----_--------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t �o-,ns�tr�uct and 'nstall the,,wwork herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- ! `------ �-^' Owner's Name------�..c... ---•-------•-------•---------------------------------------------------------- ----- Phone_��--O/....ea E i- Address-t + ---- -•---- Contractor's Name------ ---- -- -- �"�--- - � S11�-----t--- ----- - Phone-44.f�-=-.?.00_5`1 Installation will serve: Residence [ partment use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-_- Number of bedrooms. Number of baths /�ot size -_- --------------------- Water Supply: Public system ❑ Community system ❑ Private �pth to Water Table 6-Q ft. / Character of soil to-a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Q'rlardpan ❑ Previous Application Made: (If yes,date---___------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available vjithin 200 feet.) S ic, k: Distance from n+rest well-----------------Distance from fdundation-------------- ----Material_-_--_.--__.-.-_-_-_.__.-.._------__-__.---_-_-_. No. of compartrr nts--------------------------Size----_--------- - -------Liquid depth ------Capacity--_ ------------ osa did00 • Distance from neon st well---7;0 �_Distance from foundation /s. ---------� Distance to nearest�lot line.'�-p. q Number of lines_ ___ __ .___ ...___ Length of each lin __ .Q ._ _ - Width of trench_�st_ �� Type of filter maeria _Depth of filter ma enal __._..Total length_______________ o. , ------- g -- Dist— �to nearest lot lin ��:�� See a e Pit: Distance to nears t well /� Dista from oundation____. .. Number of� its - - > __.Size: Diameters _-__ ____ ening mPterial____ DC _ t_. --- _Depth... t_ ____- Cesspool: Distance frgrn nearest well _--_Distance from fo(,ndation----- ---- Lining material- -------------------------------- 171 --_------------- ------ ❑ Size: Diarjoiter_..-�`"-"-`""� _�_ ____bepth-.--_..---_-. _ __.__ -__Liquid Capacity. gals. -- - --------------- --------- Privy: Distance from nearest well--.--------------- _Distance from nearest building_______-___________-_._.___._.____-.-. '- ❑ Distance to nearest lot line------------------ -------------------------- =----------- ............. -------------------------------- ----------- -------- 1 Remodeling and/or repairing (describe):------- ----------------- -------------_--- ----------------- ----- --•• _----------------------------------------------------•--------- ----------- --------- --- ---------------- -- -- -- ----- ----- - ----------- ------- --------------------------------•----------- --------- --------------------------------------- -------------------------------------•------------------------------- - ------------------------------------------ ------- --- -- --- I hereby certif hat I h ve prepa ed this applicati�i and hat the A wi be done i ccordance with San Joaquin County ordinances, a an ule and re lations of San oa to al alth 'stric (Signe -- ----------------- --- - � (. Contractor) y v. --- ------- ---------- -- -------- --- ----- (Ti+le) - - -- '= (Plot plan, showing size of lot, location of=jiQrn in rel n o uildings, a c., can be placed on reverse side). g,,*FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- `- -`� .__� _ .� - - --- DATE ---- - ----------------------------- REVIEWEDBY----- -------------------- ---------------------=------- ---------------------- ------------------------------------------ DATE------------.,- -------- BUILDING PERMIT I ISSUED--------------- _ 4_ DATE------------ ci .Alterations and/or recomMendatiQnp:, -If r ------- --------------------- -- - ` . ---------------------------------------------------•-=-------- ------------------------------------------------------------•------------------------- -------------------------- ----------------------------- ------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------- ------------------------------------------------------ ----------- ------------------- ------ FINAL INSPECTION BY:... -------- ---- -- - --- --- ------- ',date--------` --------------- --------- ------------- SAN JOAQUIN L (?)o1r7DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street j4 Sycamore Street 20S West 9th Street Stockton,California Lodi,California 'Manteca,California Tracy,California F.P.C C.