16784 - Laserfiche WebLink

Home Browse Search

rUK UrNUL USE: l � --------------------- --- a �_ ----------------------- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..'..1.6_. .- - ---------------------- --------------------- ------------- (Complete in Duplicate) " ---------- -------" This Permit Ex fres 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. JOB ADDRESS AND LOCATION_____ Z6 1 + ` { Owner's Name--------R-O-Y------ r =----'-- -_--- --. - ----------------- --------------------------------�--------- Phone---••---------------•--------------- ------------- -•._ Address -`i � R I $� 5 --••---Rd.5----- — -- , ii Contractor's Name_______Q_c ._ _ . -t # -----------------=- - --------------- - --------------------- Phone...................... Installation will serve: R esidence a # Apartment House ❑ Commercial�0�Trailer Court ❑ Motel ❑ Other El ,Number of living units:,"----- Number,of bedrooms 3-"'" Nurriliei of baths -_. ' Lot-size ___ i .-- Q -k--I_(L),s-- Water Supply; {Public system K community system:.❑ Pri.vafe_❑�; Qepth,to Water Table__.. ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made; (If yes,dat.__ _-_-- _- f � 1 No � New Construction: Yes 5QNo ❑ FHA/VA: Yes [INo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ P ` I r ' T Septic Tank: Distance from nearest-we#l_ - ------Material . Size_ X_`� :XS" "__Li Liquid depth -Y1��"-"_-"- Capacity.S�_ .g[�i 1 , Y2— Disposal osa Field: Qistance from near est well-_W0_hlEDistance from foundation---1_>�___ ____-Distance to nearest lot p �. Number of LengthImes-____!�________________________ of each fine---------_1_0! -----------Width of french_ Type of fitter material i t 'GL�G�__Depth of filter niaferial-----I-- tt I---Total length_----2.4--Q--!------•---------- Seepage Pit: Distance to nearest:well________________-=_:Distance from foundation---.,--------- Distance to nearest lot line-_.____.___-__.._ 0 ❑ Number of pits -----!------Lining Rmaterial---- -----------------Size: Diameter------------------- ---Depth--------- -------------------- Gesspool: Distance from nearest well-_�--------------Distance from foundation-------------- . Lining material ---------------------- [� . Size: Qiameter.. '--- -------=--- ---------Depth-.-----'-------------------------...-----------------Liquid Capacity I G. ' -------gals. Privy:- _ Distance from nearest well"...-"""___--�:�: ------------------------E---Distance from nearest building_ ___"__________________ ❑ Distance to nearest lot!l. ... 3 # �1 41 Remodeling and/or - repairing (describe):-- -�iI �------T —�-- _� ------ -,e--- ------------ ----•----� ------------------------------- . . --------- - ----------------------•----------- ------------- --------- --------------------------------•----------- . ; f`.< t ----------------- ------------------------------------ --------------------------- r --•------------------ ------------------- ---- ------------- --- ------ I hereby certify that i have prepared this application and 'that the-work will be done in accordance wi#h San Joaquin County ordinances, State laws, and les and regulations of A S Joaquin Lo`caI"Health District. ( 9 }-------------- ------ ---��------ •--------------------- t I ---------- -(Owner and/or Contractor) Y. ------- -------------------�------ ---•-•------------------------------------=- ------------------ Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t r 1! 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- -,-`'-------- 5_..._ -----------•------------ -- DATE---)- -----4' ----------------- REVIEWED BY----- ------------------- ---- -- ----- ---- ------------------------------------------ -----. DATE------------------------------------_---------------------- ----------------------------------BUILDING PERMIT ISSUED-------------------'-------� r DA•TE -�... .�_..,. Alterations and/or recommendations:_..':...-"................ - • --------------------•--- i --------------------------------------------------- •------ -----------------------------:---- ------------------------------------------------ ---------------- ----- s FINAL INSPECTION BY:--,-.Q t 5---------------------- ------ Date 3' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f5 9 RCVI6EC 8-59 3M 3-'63 F.R.00.