18751 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; ' /------ ' ----------------- '` ----- -- --- ------------- ----------- -- ---- --------- APPLICATION FOR SANITATION.�` ..ERMIT Permit No. i --------------------------------------------------------- (Complete in Duplicate) Date Issuec! -----------_---------_---------------- This Permit Expires 1 Year From Date '1�– ed � 77^ 3�0-Zf e work Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t herein described. This app•cation is made in compliance with County Ordinance No. 549. ; 30 Y A �JOB ADDRESS A � "�' w - ' ----- �-------------- g6Own ' ~ � ...... . ers Name____ ------ - ----------------------------------------------------------------------- k --- Phone ------------------------------ _ _AddAddress ress ' S --•---•-•-------------------------------=----------------- ----- -- --- ---•------------ -----------------• ------ - a ...Contractor's Name---- Installation will serve: 'Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other I L Number of living units: -------- Number of bedrooms -------- Number of bathsp Lot size_-_ly-s 130_ __________________________ 9 Water Supply: Public system ❑ Community system ❑ Privateo Depth to Water Tablet/-P_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ,Clay ❑ Adobe,M Hardpan ❑ Previous Application Made: [If yes,date----------- ) No X New Construction: Yes No ❑ FHA/VA: Yes D No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .}(No septic tank or cesspool permitted if publicseweris available within 200 feet.) Septic Tank: Distance from nearest weil_•S�.________Distance from foundation___3.4----__- Material__ _` `--!''____-"!"---_._.._____. tN i No. of compartments------��--- _---- � 1� --------Liquid depth------K_------------__Capacity_o?4 Disposal Field: Distance from nearest wek__J.0--------Distance from foundation__ya_�_.___.Dlince to nearest lot line`__________ ----------------------Length of each line---SQ_R__5D --._._:Width of french----------- Y__�------------- �J Number of lines---------- y� iType of filter material _.S_'_/pdc lrDepth of filter material__._/9.__'_____._Total length----------- -_'__.__________.__. Seepage Pit: Distance to nearest wet _..t/aP --____Distance f,fN�m foundation__y5P- _____.Distance to nearest lot line----S------- �( Number of pits----_aZ-__._____._Lining material____1FaA'__..Size: Depth__.2`...... '__- --_______________ �_. Cesspool: Distance from nearest well-----------------Distance from foundation_.----------- _Lining material__.___-.-.._______._ . r ❑ Size: Diameter--------------------------------------Depth------- --------------------------------------------Liq id Capacity---- 4, {-- ---------------------gals. Privy: Distance from nearest well----------__________________--___._._._..__...._Distance from nearest building__________.-_________________-._____.___. ❑ Distance to newest lot line_- -- ------- ----------- --- ----- --------------------------------------- ------------------------------------------------------ Remodeling and/or repairing (describe�:------------------------------------------------------------------------------------------------- _ ------------------ ----------------------------- ------------------------------------------- " _ s = ' 0 S_ _ ;. 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 San Joaquin Local Health District. r (Si ned Owner and or g } � --- ( / Contractor} gY� ..-----�--- (Title} x (Plot plan, showing size of lot, locationysin relation to wells, buildings, etc., can be plata od/ n reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------------------------------- ; _ -/r�--------- ----------------------- -- ------- REVIEWED BY----------------------------------- - - - --------------------------- ----- DATE........... --- --- ........-------- --`-------•--�-------------------- BUILDING PERMIT ISSUED-------------------------------------- ---------------------•– --------------- --------------------- DATE------------------------------------------- -------------- -- Alterationspnd/or recommendations----------------------------------------------------------------------------------------------------------=----------------------------------- --•-------------- --------- , G. ( '._?-G ---------- --------- ----------- --------------------------------------------------------------------------------------------------------- ----------------------- -------- -------------------------------------------------------------------------------------------------------------------- ---------------- ------------------- - ------------------------------------------ p � FINAL INSPECTION BY:---- Date.- `--_--- _ ��r ------------------------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 0=__ 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California _, Lodi,California Manteca,California Tracy,California