20905 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I --"` I ° ----------------------------------------------------- - - �/ �a --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._. .a..l` ,S_. --------- ------------------- --- - (Complete in Duplicate) Date Issued ___ ---_ -. - -_-- _-_ ___.__ This Permit•Expires I—Year-'Froin T1afe Tssueid— 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. (/ _, ©l//ix /Qp JOB ADDRESS AND LOC _. .L�.C ... _._. __ .�tz ...__.Mn._ Owner's Name------ rye--� Ct.--'1fC/,e l ,e ? 1 .t�:........... ----------- ----- ------------------------------------ Phone---.��--W-,a-. 7--- Address...................../e = IZ•---) _/2 . . --------- -- ............... ---------------------------•-•---- ------------------------ Contractor's Name :1/�/`'' /14 l,�1-fes ---------------�`-------------------- Phone.. �'�f��,�� Installation will serve: Residence Apartment House ❑ Co era ❑ railer Court ❑ Motel ❑ Other ❑ Number of living units: -_ _- Nu'm' ber of bedrooms __ a __L Lot` ' i ._____ �t. _______ ___________ ____ Water Supply: Public system ❑ ommun' Priya.te D-apth to Water T _____ ft. gp' Character of soil to a depth of 3 fees: San ❑ Gravel ❑ Sandy_�oam;g,_Clay Loam p Clay ❑ Adobe❑ Hardpan ❑ Previous Application Maden (If yes da .-__ _ _ - _) No ❑ New Construction: Yes Pv No ❑ FHA/VA: Yes ❑ No ❑ TYPE,,PF INSTALLt1T10 16q,-AND *i& ONS: ._ ... .. .> . . �10 styptic tank or-cesspool mit public sewer is available within 20D feet.) Septic Tank.,,". Distance from e / :Distance frpm fdu ndatio----- Materia_._ _Capaci7ty`.l 12_G_ei5-Wq p e No. of compartments___ _Size____ ---- Disposal Field: Distance from near s'f"we :'Distance from .f undatiop----Z4f �r...Distance to nearest lot line___ ...... Number of lines_________ _ ! Length of each ;:Width of trench_____.a _ ____:_ Type of filter mate fL _Dept pf filter material___. .Total length________/Z729.-________ x. 1t i Seepage Pit: Distance to nearest well------ ;_ _ is r from f uundatlon--------------____Astance to nearest lot line--... __.._ _.. ❑ Number of pits------ -------------Lining material---------------- i Diameter----------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------#D'rstcnce frorrr fahrn n------------- ___.Lining material__.. . ___-,________ _______________� ❑ Size: Diameter------------------- ----t#Depth--------- -------- --Liquid Capacity- --------------------------gals. p Privy: Distance from nearest well ___ _________ _ __________Distance from dearest building________ _ ______________._.__ __... ❑ Distance to nearest lot line------------------------------------------------------------------------- Remodeling and/or repairing (describe):----A5_74f_1 .• .t2�_. 17 __�� 1J. ----------- --------•---- ------------------------------ I hereby certify that'I have prepared +his'application"and fhat'fhe workwilt"be one in`acc`or ance with San Joaquin County ordinances, State laws, and rules and regulations of the San .t aquin Local Health Dhirict. �/?` aa9'1! f� _ r_: __ --- -- -^ #'(owner and/or Contractor) (Signed) �f �., � �� By.----------- --- --------------------------(Title)------;5P.---------------- - ---- -- - -- --- ------- --- ---- ------ ---------------------- (Plot plan, showing sizQ`iif lot, cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY v1 5 7 ---------l--- ------r'--------------------- - DATE -=�--G---Z ----------------- REVIEWED BY---- -- -- . .. T ---------- ----- ------------------------ --- BUILDING PERMIT ISSUED----------------------------------------------------------'--------------- ----------------------- ATE.. --- ------------------- --------------- Alterations and/or recoir mendations-------------------------- ---------- ---------- ------------------------------------------•------------•--•---------------------------------------- --------------- -------------------- ------- ------•--------------•---------------------------------- ------- ------------------------- -------------------------------------------------------------------------I---._.. ------------------------------------------- --------------------------------------------------- FINAL INSPECTION BY ..- ___ _________ ___ _ / Date__-_._._._____7.-___�"--. .(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.C C.