13385 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: G a Permit No- ----------------•--•---- ---_---- _-- �j� - - --.-_ l__;_ v APPLICATION FOR SANITATION PERMIT � n --- -------- r (Complete in Duplicate) n I ---- --- 1 Date Issued ------------ ----------- ----- __ .___._.._..__._._______..__ This Permit Expires l Year From Date Issued 'tr Application 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. JOB ADDRESS AND.'LOC ION ! _46-------- 0 VW " "-----------------•------•---•------------------------ P Owner's Name------------- --•---•------------------------------------------- Phone-----------.--_---------------.._. Address--------1,��1-.�r �. -------------------------- -------------------------------------- Contractor's Name----------- ---------------------------------- -------- Phone Installation will serve: Residence Zi-~Apartment }-louse ❑ Commercial ❑ �Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-. Number of bedrooms ,;_ Number of baths/.�, Lot size. __�._.----_____._-____--.-__.-- Water Supply: Public system ElCommunity system I-rivate E] Depth to Water Table Vt. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 10--pardpan ❑ Previous Application Made: {1f yes,date----------__--------}' "No--[V New Construction: Yes [i—< ❑ FHA/VA: Yes 94-*'go ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) Septic T k: Distance from nearest well ____ _____ Distance from foundation__,�op---------Material__d_�i,� - _- .-.____....- p - i No. of compartments.--j________________Size X"_X__b _Kiquid depth____.ff -------------Capacity_Ir.QQ___._ - p Number of lines_____ HTS---Distance from foundation____ __ _- ----- ml-**", / rn � � --- ��......--Distance to nearest lme__+i�_�_____. i Disposal Field: Distance from nearest well._:.-- Length, f each line_.-__. _ ----------Width of french---A .... Type -q See a e it: pis e ofef hoer material Depth loof filter material__ /r__-_._Total length_., __ --------- Seepage ________Yp {-• - ______Distance from foundation..../�i�_____...Distance to nearest lot line__%$......... Number of its___._ ________- rr P 9 • ��r p salG� Lining material-_;e- Diameter__�„��----------IJepfh_.e;pl ------------------ { Cesspool: Distance from nearest welL________________Distance from foundation---------------------Lining material-------------------------------------- El Size: Diameter. Depth`-----------------�---------- ------ ------------- Liquid Capacity gals. Privy: Distance from nearest well----------------- _______--:_____--__________'__Distance from nearest building________________--__-_----._-_-__._____._. r ❑� -Distance to nearest,lot line -- ------------------------------------- ---------------------- --------------------------------- Remodeling and/or repairing (describe)-------------` -----• ----------------------------------------- -------------------------------------------------------- ----------------------------------------------••---------------------- - -- --------- -----------•-•-•----•------- 4� I hereby certify that I have prepared this application and that the t work will be done in accordance with San Joaquin County ' —ordinana Statetaws, and rules and regulations of the San Joaquin Local-Health District: + k t ��s� "�--" /or Contractor . {Signed)--------------- ��2f�7"a'` �'o. ---------- --- - ----------------- - _ ) a A-- ` B - ------ {Title} �' V(Plot plan, showing size of lot, location of em.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r ' 'APPLICATION ACCEPTED BY-_e------ ----- - r [1 � _ :. : DATE ::__J-: '- . ._ REVIEWEDBY----------------------------------------------- --------------------------------------------------------------- ------------- DATE-------------------• ------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------•-------- ---------------------------------------- --• DATE-------------- ------------------------- Alterations and/or recommendations:._ .,,,,>- ----------------------•- —------- F 41------------------ - --- ---------------- --- r ------�.......;;� •.. ---1 ----fit ---- . .----- . ---:S- ct .- `.� -s - . .: ----------------____---------------------------- '-----------------------------..-_-______..____-______-.--w.__ ----------------.--.-.-------------------- ...._..__--_...._-._.._-__-_-._.._.- FINAL INSPECTION' BY:_ _�L72_._ Date________? -- ---7.. .... �`---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycornaro Street _ 205 West 9th Street Stockton,California Lodi,Californla Manteca,Californlia ri a Tracy,California EG-9 REVIBEf]