79-516 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE.., ---------------`--------------------.------.------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ----------- __^Sr _.----------- ----- -------------------------- (Complete in Duplicpte) Date Issued --..--------------- — ---------------------- This Permit Expires 1 Year Froin 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 Oidinance No. 544. I JOB ADDRESS AND LOCATION--------'� i Owner's Name----------11rq---.... �%S• ¢---------I---------------- Phone..s�3- / ----------------- --------------------•-------------•------ Address-----....rzf.T_r_-�3--------------�i`ve>' Ad . 3G1• dlt!. --------------------------------------------------------------------- Contractor's Name..... !. /7`tf4rY ._ Soli'!-_. 1+ ,- �I��'_ �6.... s Phone.. - .............. Installation will serve: Residence Apartment House ❑ Commercial`0, Trailer Court.❑ Motel ❑ Other ❑ Number of living units: __!____ Number of bedrooms ----�V---- Number of baths____ Lot .................................. Water Supply: Public system ❑ Community system ❑ Private 0 Depth To Wafter Table ........ ft. Character of soil to a depth of 3 feet: Sand JK Gravel ❑ Sandy Loam ❑ Clay Loam 0 Cl-ay-[j ,;Adobe E]--Hardpan-Q,: Previous Application Made: (If yes,date_..------------ ---J- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well_-/-*_0_`!___Distance from foun'dation--- ❑ compartments .........Material cOn'G ----------- :* ;#,* No. of _._____.mo._--___---- --------------Capacity-/6d0---------- � Disposal Field: Distance from nearest well__f�___Distance from foundatison__ S--'•____Distance to nearest lot line. ....... ❑ Number of lines----------7-------------------__Length of eachline__��_'___�,�________-Width of french___�y'v..:..___.....-__.... Type of filter material._.A<1e.___..---Depth of filter .rnatekal'_x__ry___ _________Total length----- - ------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits----------------------Lining material--.-----_.-----€s`_.Size' 'Diameter-----------------------.Depth--------------------.--.--------- t Cesspool: Distance from nearest well_________________Distance from foundation-----.--------------Lining material----------.----------------------_- Size: ___________________--_-Size: Diameter--------------------------------------Depth.---------------- { --- ---------------------Liuid Capacity gals. Privy: Distance from Distance-from nearest building__________________________________________ ❑ Distance to nearest lot line---------------------------------------------------------------------_2--------------------------------------••---- -. --------------- r I Remodeling and/or repairing (describe),______________. ) ---•-----.....•--•--•--------------•----------------••---•--------•--------------•-•-----------------•------------------------------•-------------------------------..----•----........------------------------------- ------------------------ --------------------------------------------------•----.------------- --•------------------------------------------------------------------------------------------------------------------------ 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. (Signed).......... �Wl,'fA V-----•4. ��--------- ----------------------------------------------------------------Owner and/or Contractor) BY: - ------------ -----=•--• --------------------------------- ----Title------ Y (Title) (Plot plan, showing size o dt, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). I F DEPARTMENT USE ONLY APPLICATION ACCEPTED,_BY-•--- - --------------------- ------------------------------------------------- DATE-------- �� 1_ REVIEWED BY --------------------------_- DATE--------------------------------•------- ------------------- -------------------- BUILDING PERMIT ISSUED.......-------------------------------- ---- --------- ------------ DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- I t -----------------------------------------------•--•---•-------------------------------------------------------------------------------------------------------------_--------•----------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ---------- -• '. , ------------------------------------- ---------------- ----------------------------------------------------------------------------------- ------ ----- --------------------- FINAL INSPECTION BY:_. _ ;--k------ 'Z ------------ ------ - •-- ------------------------ - Date � /6,o / Cq/-Z�( Dy °~W, 'SAN JOAQUIN L CAL HEALTH DISTRICT 13 an Sfrnt *300'Wmt Oak Stmt 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i ES 9 REVISED 8.59 2M 5-62 ATLAS