16279 - Laserfiche WebLink

Home Browse Search

Y KU1`1-lUt USE: _._______ __._ APPLICATION FOR SANITATION PERMIT Permit No. _.-_---��_._�_�. ----------------- --------------------------------------- (Complete in Duplicate) J/ -- --- This Permit Expires 1 Year From Date Issued Date Issued ....._ ..._.. !h� 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 wit County Ordinance No. S49. c fr7Lf X -- JOB ADDRESS A LOCATION__. -�--- I� Gl. l.,rt1..:..:: ._ :.:I1t-Eye: -- ---------73 --2-30--------- ---- l-5 j Owner's NameC�/Pr.....�.j -- ,h --------•----------------- Phone.. Address.......... f ...f -�.-------- r`r ------------------------------------------------------------------------------------------ Contractor's Name. i ------•- -----------------------------------------------------------------------------------------------------------•------ Phone................................... Installation will serve: Residences Apartment House ❑ Commercial [] Trailer Court [-] t,Motel ❑ Other ❑ Number of living units: ____/__ N ber of bedrooms __12 umber of baths__ Lot size .__ ! _y?�/�._�.-------------------- Water Supply: Public system Community system rivate ❑ Depth To Water Table_-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ So y Loam L] Clay Loam ❑ Clay E] Adobe�nrdpan C]Previous Application Made: {If yes,date------..__---------I No New Construction: Yes Me"No ❑ FHA/VA: Yes ffT--I�o ❑ ,J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) °4 Septic nk: Distance from nearest well____. ...Distance from foundation-----/! ..Material- -�r/C1r------- 19 No. of compartments______ - _-_----._Size___- ..Liquid depth__',11 - ----------capacity-----e5&v..... a Dispos Field: Distance from nearest well._____Distance from foundation. l_o Z_ Distance to nearest lot Number of lines--------- Length of each line..... __ ------ -- �r�'f-7 ----•.Width of ------------ Type of filter material._. _��-� Depth of filter material- -!i--------Total length_/,�.L_________________________ Seeps it: Distance to nearest well----- Distance from foundation... ! _./.....Distance to nearest lot . •- Number of pits----.._.-.r�________Lining materiaLY!.?' _�... _.Size: Diameter_�.��L_._...__.Depth____c��!._._�E�,• nS Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material--------------------------------I.... / ❑ Size: Diameter------ ------------------------------Depth-------------------------------------------------------------------------Liquid Capacity--------------...............gals. Privy: Distance from nearest well-________________________________---_-_ -------Distance from nearest building______.____--_-___---____________..____._. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------- Q --- ---------- Z --- - -�-I�------ -.. ---- 1?._h1------------•-------• ----------------•----...........•-------------•-------------•------------------------------ - ---------•--------------------------------------------•------------•----------•----. ---------------------------------------------------------- • ----- ------•----- ------ ---------•-•- ------------ .�- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stats a and rules ulations of the San Joaquin Local Health District. (Signed)--------------- --- .. _.. ---•-•--� --- - - - ------------ -----------------------•- -- ------• -----•- -- - --------------------.(Owner and/or Contractor) .r By:.-- r -- - --------------[Ti+le}.... �� (Plot plan, showing siz of to , Iota+ion o� system in relation�ke-wii buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -•-----------p--- --.�:�'��--------------------------------------------------_ DATE----------------•„�,-+-- -.-��•?------------------ - REVIEWEDBY--------------------------------------------- ----- ------------------------------------------------------------------ ------ DATE-•-•-------_-------------------------- -------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------- ---- DATE Alterations and/or recommends+ions7/------------------ --- ----------------•-•---- ---•---•------------•--------••----•-•-----•-------•----------••------------ ------------•--------------------------------------•----•------------...-.----------•--------------------------- ..- -------••----------------------------------•-------•----• ----------------------------------------------------------------------------------------I.......... ------------------------- ------------•-------- ---•-•------- _ ............. ---- - - - - ---------- 1 -- -f.--. ,.. -----. . ' --- '- - . wx FINAL INSPECTION BY:------- - .c± ---------------------------- Date---- = -6-3-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS