21887 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: ---------------------------------------------------------- rte, ____________________-T_-______-_----_---____- APPLICATION FOR SANITATION PERMIT Permit No. . ....... - (Complete in Duplicate) Date Issued 3._-_. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health'Disfrict for a permit to construct and install the work herein described. This application-is made in compliance with County Ordinance',No. 549. 11 JOB ADDRESS AND LOCATION..,-j . - -------------------------------------------- ' Owner's Name----- ------- - - + .�/ Jam`—taZo� ----- ---------------- --- ------- ..� Phone-----•-•-------------- Address-------� ---�--- ...--• . -.r � -- ---•_ ......"".` -- -- Contractor's Name--•---- ---- --1�••------ - -----•- -- --------•-� Phone-----—A -------------- t 76/9 Installation will serve: Residence Apartment House [] Commercial ❑ ,tTrailer Court ❑ Mote! El Elr Number of living units: J__ Number of bedrooms 3_�Number of baths _-Lot1.size ____ -jQ�0-----L-i____ _______________________ Water Supply: Public system [3 Community system E] Private Depth tosvater Table 3,�_ ft. t ~ 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy oVn-o Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.__.`____...........) NoNew Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic Tank or cesspool permitted if public sewer is available within 200 feet.] a ._- I Septic Tank: Distance from nearest well_________________Distance from foundation---------------I----Material-----_--_____________- I_____________.._---_____. ❑ No. of compartments--------------------tt---``---Size------------------- �-------Liquid-depth---------------- --------�CapacitY---------------I------ Disposal_Field: Distance from nearest well-s-4—Distance from foundation._ -__ _._.-_._~__.Distance-to nearest lot line__----_____ Y Number of lines_____________ _ _ __u _._.____Length of each line_____--._ _ [ Width ofFrench_ - ��---------- Type of.fiiter-material--_ .Y.�__ __ Depth of filter material__�_�_�.-_4_____.Total fiength__�0`�__�__________________ Seepage Pit: Distance,to nearesf4well_e_j_,/lge------Distance from.foundation___.11 ______:p istance o nearest lot line____'_.___.. Number of its______-__ Y p _ -------Llning material---jOC_K.Size: Diameter`:"z: y__.-_____--Depth---- '-`� -r-\-'j---t- Cesspool: _ ' `Distance from nearesawell------ -------Distance from foundation-------------------.Lining material__.-..-___.__---------------------- Size: _-----____�_ Size: Diameter-__-__ :-----------"=--=--- ___.De th-_,------t --------------1i uid Capacity t� gals. ❑ 4 r . . P q p y-------� ----------------- { Privy: Distance from nearest well-------------------------------------------------Distance from nearst building__-_______.___.__________--_------------ L,w❑ Distance to nearest lot line = r----------- Y ----------------------------------------------- Remodeling and/or repairing (describe):-_ .. _- ------------•------•-------------------•------------------------------- � , -------•---. ... -------------------------- --------- --"--------------------- ----------------------------------------------------------- ---------------------------------------------"--------------------------------------- -------------------------------------------------------------------------- - 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, and rules and regulations of the SaA Joaquin Local Health District. -----------!----------------------- - ---Si --------- (Signed)--o ..Owner and mor Contractor) By:-----2��sysfem -----------------------=:-,--------------------------------------------------- (Title} �oneme [Piot plan, shf syn+em in relation to wells, buildings, etc., can be placeside]. + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------`"r`c_R_0-------------- ---------------------------------------------------- DATE------- ` j ' ------------------------- REVIEWEDBY--------------------------------------------------- -------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------:---•---- •----------------------- DATE--------------------------------------------- -------------- Alterations and/or recommendations------- ----------- --------------------------------------------------------------------------------•--------------••--------•------------------------------ ------------------------------------ -----------------•--------------------------------------------------------------------------------------------- --------------- --------------------I------------------------------------ -------"-------"----"---------"-"---"------------"-------------- --- ---- r------ -------------"------------"----------""------"-------------------------------------- " ----------------""---""-"-"----------"---------'� ----- --- ---- --- - -------"------•------------------------ -------•-----"---------_--•--•-------- ------------------------------------------ FINAL INSPECTI N BY: r71T1� -=__-- _"-- _ -- n� '�_ Date------------�--_-"1_ 7,- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Marlton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.PZD.