21381 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- — ��^• -------------- -------- --------- -------------------- ------F-gid---- --------------------------__.---.F+gid-.__ --- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. I ._ � --------------------------- ------ (Complete in Duplicate) w.� ----- ----------I--�; �-- 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. _, fir-Syr7 61,4Y i JOB ADb12ESS,AN CATIO -1----//-,--- 1- �� - - --4. . "_s_. =1 _ . Owner's Name ) - � ------------------------- ------------ ------------ ------ Phone----- ------------------------------ Address J---{ �f�:CC»� =fit Contractor's Name-- ----- - 'Q------ C Phone.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4 1--- Number of bedrooms -3-_- Number of baths4?, --- Lot size Water Supply: Public system [I Community system ❑ Private [j/EJepth to Water Table 4-k- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe �ardpan ❑ Previous Application Made: (If yes,date--------------------) No P/New Construction: Yes LKNo ❑ FHA/VA: Yes Rl_*"No ❑ . t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F::r _J A ��jj it �,� Septic/Tank: D}stance frominearest weli___vk�_1_..._Distance from foundation-_X-.-_-.-.--__-Mated.__ Riin:- - - I N. No...of compartments-__21--2.2--------------Size-----4if-�C-- -�'-----------Liquid depth......*/_ �_---------Capacity--.��--- --- Disposal "Field: Distance from nearest wef!__!'F-------__Distance from foundation__- -----.---Distance to nearest lot line---�f:---- Number of lines _�---_-_-2--__ -_---------Length of each line_---_ �i 9 �`�- --- Width of trench----�-y-.-�----------------- Type of filter material____._-� .--_��o��pepth of filter materia!-.__.� . �....._.Total length_____/ ------------------- - Seepage Pit: Distance to nearest well---I_C'C_--_____Distance f undation___ 6__r---__--Distance to nearest lot line- --------_.-_.. { -: .� ------ Depth_ �� n ❑ Dumber of pits------ material -------------- Size: Diameter_ p gg ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation________________ -Linin material___..___._________ ❑ Size: Diameter-- k f- -------------------- ---Depth---------.- -------------------------- ------- Liquid Capacity-----------------------•---gals. Privy- Distance from nearest well------------ -----_------_-+__------ -____Distance from nearest building_____.._______________.___________ ----- ❑ Distance to nearest lot line--------------=-�---------.- ---------�-------.-------- ----__-- Remodeling and/or repairing (describe) -------- -------- J-L__L,.0 fes= J f ---------------------------------.td ---------------- I -------------------••------•--------------------- --------- ------------- -- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------`-_--------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa ws, and rules and regulations of the San Joaquin Local Health Disfricf. (Signed) . ~ . ------- ----------------------------- ------------------- ----------------------------------(Owner and/or on rat 1 By: = �� --------------------------------------------(Title)----- -- ----------- - - -----(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.'can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- Q_M--- --- ---� DATE !yl /�6 REVIEWEDBY ------------------------------ ------ - ------------------------------------------ DATE------ BUILDING -------•---�---- BUILDING PERMIT ISSUED----------------=------------------------------------------------------------------------------------ DATE Alte a and/o r commendations: --•------------------ ....... >� a 17/6 -� ------------------------------- `-�•�-_l�-�.--.ra�.�i.,_..1..1�_.rx.��-.�-- ---�,r,�`1--�'-�Y��-_.c.�-�s:��.�•�'7� ..� - --------- -----_... ------ - - --- -------- ---------- -------- -------- - ----- ---- FINAL INSPECTION BY:.........(✓l�------------------------------------------ -- Date.- ------ - I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California F.P.0 O.