22669 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:,, ryI tl /35 3 1 -0 -- --- ------------------......... ------------- APPLICATION FOR SANITATION PERMIT Permit No. -_�a�.:� - - (Complete-in Duplicate) .................. This Permit Expires 1 Year From Date Issued Date Issued Z zfo�-f 7 0--4.9 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.E �17C ,� r JOB ADDRESS AND LOC?TI I OF ---��C� ----- ------- Owner's Name.-----• -------- 'i --rq; nPb oner ...-.. Address_;/0 {.11-Ta - �CT o I- s----- 411 ll-- o 1�.� - 1 �' fY__-�7KG Contractor's Name----VWNfi.�;M.t_. -------•--•--- ----------------------------- ':�- ------ -- -----------------=--------------- Phone----------------------------------- Installation will serve: Residence ®/A artment House Commenciai ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I. ......Number.of bedrooms-3___.. Number of baths./-.-_-_ Lot size --; —---------------- -------------------------------- Water Supply. Public system ElCommunity system ElPrivate epth to Water Table -1� - ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam t❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes ,date....:.._._____._._ ) No,�New Construction: Yes ❑ Ni FHA/VA: Yes D---No ❑ ! TYPE OF INSTALLATION AND SPECIFICATIONS: i Se tic Tank: p Distance from Dearest welL_ ___._..___'Distance from fou within 200 feet.] _ � -..;...-- - , rT _ . se tic ta_n or cess ool ermined if. ublic sewer is available ndation---_..._.____--_. Ma''#erial .__--------------------------------- No. _"-.._.__.__...-._ . ❑ p Size Liquid depth_ ------ --- Capacity Dis osal F, Id: Distance from nearest well._. .Q. 4 r, ro o. o compartments-_'....:..........._ ___ P � 'S D+stance=frorriJfoundation/t�.__."_._....Distance to nearest lot line__5�_.___ � �s Number of lines.-------_ - ----------,Length of each line-- ---------------------------Width of french__------------------------------.-. Type of filter material_-- __ r Depth of filter material----e�?�.�.<____....Total length---------ti.?G'._"`_--"-_""""_"_---- Seepage Pit: Distance to nearest well---------------- ---Distance from foundation--------------------Distance to nearest lot line---_-...__.__---. ❑ Number of pits'-- ---•---- . --."_Lining material------------_------- Size: Diameter.---------`-------------Depth---.-N,-- Cesspool: Distance from nearest well ----------------Distance from foundation.---------------- ..Lining material_..._._.---__________ -----_------- ❑ Size: Diameter- - - ------------ ----------------Depth-`_=---------- ------------------ - --------------Liquid Capapify--------= -... --..gals. Privy: Distance from nearest well---------.........:... _ mm_l-----Distance from nearest ❑ Distance to nearest lot line ---------------------_------------- .------------------------- �. Remodeling and/or repa+r+ng (describe):____- : - ----------------- ---------- ---- 1 ) l 1 i i ----- ---- --------------------------- I-hereby certify that I have prepared this application,and-that-the-work will.be done.-in accordance with San Joaquin County ordinances, Stat f 1ws, and rule an d r ulations of the San Joaquin Local Health District. i (Signed} - ---- - ------ ----- I -- - ' == '=` :. -"---------.°.... l ------.(Owner and/or Contractor) By: ---'--------------------'---- -- - - {Title).. _ --- --- ------------ ------- (Plo+plan, showing ze of to+, location of system in,relation',,to wells, buildings, etc., can be placed on reverse side}.�` x FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------_. ___ m - -------- - -------------------------------- --- ------ DATE ti REVIEWEDBY----- --------------------------------------------- -------------- -------- --------------------------------------------- DATE--- ------- BUILDING PERMIT ISSUED.------- -- =--- ----------- ----------------------------------------•------------- DATE_J_----------------- Alterations and/or recommendations:. - -- ---- -------------------------------------- _.__... -- _ - .- _._._ - ----- ---------------------- --- ------------..------------- .5 �i1" --- _----------------------- -....-_ - _x 1'. 1 ----------------- -•---- — _ _ - —_--------- ----------- ------ ------ ----- ------------ --- -----'---------- 4V--- -- - ---------------Z_ f FINAL INSPECT Date...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street •i ' Stockton,California Lad!, California Manteca,California Tracy,California E.H.9 2M 1"67 Vanguard Press F x