18619 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:\, It i1_ I ��' PPLICATION FOR SANITATION PERMIT Permit No.'-.//(1./��.. ----------------------- ------ (Complete in Duplicate) .3 j F— ____-___.____________-- ---- This Permit Expires 1 Year From Date Issued Date Issued ___. . . 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 LOVIN ---------- rf�. I --- .. +._iCLI Owner's Name------------ r??..� - -------------------------- Phone' fcS',, ------ Address...........................................Jr_, �-.----------sem r------ //.' 3. •E'7----...--------------------.....----------------------------------.. Contractor's Name________________ ,rr�_ ��_/_ _____.�_ ------- Phone.. GYl . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ol Number of living units: ---/-_ tuber of bedrooms ___'1e5Number of baths _/.__ Lot size __.____ -- __�_________________ Water Supply: Public system Community system ❑ Private E] Depth to Water Table _.. ._._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam ❑ Clay Loam 0Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No E+ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material----------------------.-------------.___-_-_--_-. ❑ No. of compartments--------------------------Size-_.---------------------------Liquid depth---•----------------------Capacity----------•----------- DisP�2iw Distance from nearest well______ .�._Distance from foundation_ __ Distance to nearest lot line../_.___ J �i Number of lines_-_.____.__/________ Length of each line________. _. Width of trench-_ _ ___________________ g �d? y Type of filter material____.$ �/L�Depth of filter material----z ----------Total length-------- _Q__ _____________________ See pag P�:�-Q Distance to nearest welL__.____�-------- � �GfG/ Distance fro foundation to nearest lot line___,.______ � Number of pits__.__.._____-____Lining material--- Size: Diameter--- 'l_. --------Dept h-----.2 '_-__-___._-__- 6 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.._.._.__.____________-.___________. ❑ Size: Diameter---------------------------- ---------Depth----------------------------------- ---------------_Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------.-----Distance from nearest building____-______--_______________-.-_____. ❑ Distance to nearest lot line---------- ___ Remodeling and/or repairing (describe):------- 4:55J /.5 __-----------CY ,� �p --•------•---------------------•-------------------------------------------•-----------•-------------------------------------------------------------------•-------------------------------•-------------------- ---------------------------------------------------•-----------•--•------------------------•----------------------------------------------------------------------------------•----------•---••-------------------- i0 ------------------- ----------------------------------------------------------------------------------------•--------------------------------------------•---------------------------------------------------------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la rules and regulations of the San Joaquin Local Health District. �°�fS (Signed) ----�----- -, •l�__4f_'-------------------------------------------------- -------- n and/or Contractor) By:--_---------------- ----- ---------- .tet (Title) ............. - - ......... (Plot plan, showing size o lot, location of s tem in relation to Wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ZIr Z7 APPLICATION ACCEPTED BY------ -------------------------- ----- -------------------------------------------------------- -------------- DATE--------- REVIEWEDBY--------------------------------------- ------------------------- ------ DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/ rommendations:---- ---------------------------------------------------------------------------------------------•---------------- ------------- ----- -- -- J.... ----1�� ------------ ------ -- ------------------------------------------------------------------------------------------------------------------------ ---------------- ---------------- -------------------------------------- ----------------------------------------------------------------------------------------------- ------------- ---------------- -------- FINAL INSPECTION BY:------� l;r-9----------------------- -- --- Date.----- _e�ff--=9- f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.