16492 - Laserfiche WebLink

Home Browse Search

!}� FOR OFFICE USE: III I * ..___.___.___.._____ - APPLICATION FOR SANITATION PERMIT Permit No. 3� ' , - u (Complete in Duplicate) x. /d 7j f l .;-- This Permit Expires 1 Year From Date Issued Date issued .__......-�....... Application is hereby made to the San Joaquin Local Health Di i�iet for b perr"m' `to construct and install the work herein described. This application is made in compliance with County Ordinance'No. 549. JOB ADDRESS AND LOCATION-------- -----------------j.E_&_k_n-------- N. Owner's Name----------- ----------��A_�.11--- -------------------------------------------------- •------•------ Phone.140---- Address = = (3iM ----------=--------- -------------------------------------------------- ] ---------------------- Contrac+or's Name l . _ .... .!t •! Installation will serve: Residence A partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units ___ ---- Number of bedrooms --- __ Number of baths __ Lot size _'6-0 Water Supply. Public sysferti Co nmunity system ❑ Private ❑ Depth to Water Table _ d ft. Character of soil to a depth of 3 fee+:, Sand L] Gravel ❑ Sandy Loam F] Clay Loam 0 Clay L] AdobeZ Hardpan ❑ Previous Application Made: lllf yes,date--------------------] VFNo New Construction: Yes E] No FHA/VA: Yes ❑ No) TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) :_- Septic Tank: Distance .from nearest well---------------I Distance from foundation-------------------Material___----__----_--_--._--.---__------_---___---_-. F1 No. of compartments--A,;"=------------- Size-------•------------------------Liquid'depth---------------- ---------Capacity----------------------- ? Disposal Field: Distance from nearest eILY:_Distance from foundation___ _��-_-_Distance to nearest lot line....__------ Number o t - A1i4_ , f lines : Length of each line '�-3� ---------Width of trench.--------- i---:_5/------ ' offi Iter material___ jr_____I Depth of.filter material--_-- _a��____._To tai length_._._.__________________��--------- Type �! Seepage Pit: Distance II € to nearest well-�Q>AI_ g_ _Distance:.fc� fou ation___._ _p:_________.Distance to nearest lot line__________._. s� � Number of pits_.___�.�_�"� " Lining Size- Diameter.---------- Depth--------------------}__-___ Pp # V, Cesspool: Distancei rom nearest we#1------------------D.istanca foundation,---.---------------Lining material--------.----------------------------- 0, ❑ Size: Dia eter--------------------------------------Depth-------------------------------- -----------Liquid Capacity----------------------------gals. 1 Privy: Distancelfrom nearest well---_----------____________ __ _____________Q.istancexfrom nearest building---------------____._-___ ❑ Distance to nearest lot line-----.--------------------- a ------------ Remodeling and/or repairing. (describe) [ ----- �S=%. _1`�_ .----•- - YS-- ----Z----------------------------- 1I -'f. ( f I -------------------------------------------------I------•------------- t ----------- ------------------------- --=--------------- I hereby"certify that 10 ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ruleess�and , 'regulations of +he San Joaquin Local'Health District, i (Signed)----------------------- --•---I!_............. ,1 ---------- -----------(Owner and/or Contractor).` I ¢Plot Ian, showing size of to}--------- Title ( p Iota+ton of sys+em.in relation to wells, buildings, etc., can be placed on reverse side). !I� i FOR DEPARTMENT-USE ONLY... APPLICATION ACCEPTED BY �`` - ` ---------------------------------------- DATE -----`--- REVIEWEDBY-----------------------i--------------- ---- - - -- -------- --_----•- -------------------- ----- DATE-)-------------------------- BU IeraI ions and/or recomme I-=---------- I-----•---f-------;---------------_---------- ----------------- ------ DATE______ v: -------------�-------------�I �.._. 2 , / oda+ions:--�---�-�- -----'�-�---�-- .---------• --.. _..----�---•-------=��'�_�--•-•-=---�•---------r-/'-L'-`-=�-•�-f'-----r-"--'-"-=--- BUILDING PERMIT ISSUEQ_ _ r• a- Ckr.v = i , ,_ L _ r[c, r2... ------- -7 - 7-------J---------1M------=- = I. # .r Glia--�— y - FINAL INSPECTION BY:.--- 1 Dam#------------------------ :Y � F � ------ -- N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISEO 6-59 3M 3-'63 f:P.00. I