11741 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _.11.7.... .. (Complete in Duplicate) s N. '/ a Date Issued This Permit Ex ires,l Year From rDate Issued r 3i±' Fes : � t �' �► Application is hereby made to the San Joaquin Local Heal+h-District fgr.a permit to construct and install fh ork herein described. This application is made in compliance with County Ordinance Ido. 5492 'A 41, . , r r w t .. JOB ADDRESS ANDELO T� N_4_--. . _ aFr4 - - Owner's Name_''-` '`s.`.- Phone Address--------------------------------- ----._..k._.----E•------..."` .?---------------------------------f--- ----------------------------------•---------------------------------------- Contractor's Name--- ---- = -------------------- `------ - --------------------------- Phone----------------------------------- Installation will serve: ResidenceApartment House f Commercial TrAiler Court ElMotel ❑ Other ❑ Number'of living urns:=_____"_ Num'ber of bedrooms _F "� ` . _--Number of`baths _: __ Lot•size =-_.- -- ---./�^l,�_�------ ---. -•- - -- Water Supply- Public sysst m[Community system Private❑�-Depth�to`Water Table U�ft. At a Character of.-soil to a depth of 3 feett: Sand ❑ Gravel Q Sandy Loam ❑ Cl p Loam ❑ Clay ❑ Adobe�ardpar�❑ Previous Application Made: Yes � oLE New_Constrr5ttion, Y.es={']°^`No[�"'"FHA s ElNo ) i l5�SPtC�IFICATIONS: TYPE OF INSTALLATiON�A�A,S, Fwit*.Iiin 01�e (No septic tank�or cessp I PVr i�d if public sewer is availableet:) .' e r s Sep-KcTank- Distance from n�arest well_-'L4rAQDistance from fou dation _a,-�-- - Material_._--_--1______________________K4 t ---._� t No, of com artments________'A_______________Size..._...._______.___ ___ .__wluid de th )Capacity L� P q P , P Y Dis o al Field: umab r ofol nes crest we I_- � isf ath of eachou -at'on � .......Distance to nearest lot line_ 4Jr_-___'::.. - I -- . r �7 Width of. trench.----- 9 of �• �, 1----- -�.. . Type of filer matenaL___ Depth�of filte,_,.a.terial _ / t Total length_ .___, �_______-_ eepage Pit- ` istance to nelrest well______ Dig an a f.r'om foundatior�_______________.Distance to•nearest lot line:_�_�_:____.__ • _ m umber o pit . "' i g P �`^ ' _Linin atsal �-- -------ISize: Diameter---------- - ------De th y l Cesspool:� •'�-Dista�nce � mnearest well:______�_______Di�i#ante kfrom foundation__________________eLng'niat.erial-a`_.r__'--------------------------- El Size: Dia st� - - f Depth s Liquid Capacity --'-gals. " Priv Distance f�ro-m nearest well----------- * distance from nearest building -_-______�_____________ --- C. ❑ Distance to nearest lot,line. --------------------------------------------------------------------- --- --------- ....... w.t= `.` ------ .x - ,_l Remodeling and/ repairing '(descri�ie�: ! ;- - -- ----------------- ---------- - -- ------ --- p----- -�-------- _e-- --� -- ---- --- --- ---------- -------- ----- --- ••----.--•-- --- 9 - -- - -- --- ---- 0 - ------•----------••---•------------------------------- -------------------- ---------------;,Z ------------_---------------------------------- ---------------------------------------------------------------------------------- ------------------------------- I hereby'certify'fhat I have P epared this applicati n and that the work will be done in accordance with San Joaquin County ordinances.iStafe I ws,,and rules,and regulations of fhe,San Joaquin Local Health District. (Signed =- ` (Owner and/or Contractor) R --------------------------------- ----------------------- - ----------------------------------------------- -- ---------------------------------------------(Title)------ --------------------- ---------- ---- r (Plot plan, showing,size of lot,location of system in relation'to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BYE .- �-- - -- ----- -------- ------------ `--------- DATE_�`_.`�'1_-----'___� REVIEWEDBY`= ------------------ - -----------------------------------__ DATE----------------------------------------------------------- BUILDING -------- •--- - --BUILDING PERMIT ISSUED-----#----------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations----------- --------------------------------------------•-7•-------------------------------------------•-----•-••-•-- ------------------------------ ----------- + 3 �0 U ------ ----- -- -- --- - --- - ---``-" - - - - -- - •4 - -- -t--- FINALINSPECTION BY--------- ........ ----- ---------------- ------r- �a ---- `--------------------------------------------------- ACAL HEALTH D15TR1 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North •'C•' Street Stock+on, California Lodi, California Manteca, California Tracy, California [ ES-9-2M Revised 0-'59 F.P.Co, 7 2 1 7 t 3