19993 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---- ----------------- ----------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. 1 ------------- ------------------------ (Complete in Duplicate) Date Issued This Permit'Expires 1 Year From Date Issued n_ rr Application is hereby made to the San JoagJin Local Health District for a permit to construct and instail the work herein des4ribed. j This application is made in compli,app a with Counfy Ordinance Na. 54 2-0 ID30-rs _MMtt JOB� ADDRESS AND �CATION_ IfTH - 6,7 i2---------E---- o ---COTTA - Owner's Name IR Av---•--- -;-- ----- 1 ---------------- ---- Phone--------------------•---------•----- Address � -p N--------------- -- - ------ �. Contractor's Name--- l3iE----Dar----------------------------------------- --------------- - - ------------------------ ---------------- Phone---------------------------------- Installation will serve: Residence-l�r Apartment House ❑ , Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:$___!_ Number of bedrooms --�_ Number of baths , ___ Lot size --------3�_./ -� -- ------ i . �/ Water Supply: Public system El I Community system ❑ Private �epth to Water Table"_19/ -_ ft. Character of soil to a depth.of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ t Previous Application Made: (if yes,date------------- -.) No Fr__New Construction: Yes Er--No ❑ FHA/VA: Yes P�t"No ❑ .�T-Y.P_ESO.F.;INSTALLATI.O.N-AND.,SP-ECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance fioA nearest well---5O..__Distance from foundation----�p___-_-Materiai_4f /V_C.RE- No. of cornea tments_____. -____ Size-_ -XI��_r-_Liquid depth/ � Capacity__f Qa___ (� Dispcs field: Distance from inearest well- —5-0-.__D` nce m.,fpuaciation__f_Cd;______-Distance to nearest lot line__-,?__,_:-__ Number of lines--------:-:- � Le h o�eac�i fin -- - ------ --- -------- Width of'trench--,_,2��-�-- -------�t Tye of filter material-__ . _0.-C-1--Depth of filter `material_._.._____.__.Tatal length ------ --------------- P n.! s � A A Seepage Pit: x. Distance to nearest well------_______________Distance from'foundation.______________-- Distance to nearest lot•line--------_______-_ i ❑ Number of pits---------------------Lining material------------ -------Size: Diameter--:----------------.---Depth_---------------------.-.-----. Cesspool: Distance from nearest wekf----------___ __Distance from foundation--------------------Lining material__._--____-______-_-_________ ------ ❑ Size: Diameter---------------------- --------------Depth------------ ------ ----------------------Liquid Capacity--c } ---------gals. Privy: Distance framl•nearest well-----------------------------------_____�-_--->.Distance from nearest building=__-' _-..:_______.._ -------- _ ❑ Distance'to nearest lot line_ t ----------------- ------- -------------------------------------------------------------- ----------------- ------I--------------- Remodelingand/or repairing(describe) -------------------------------------------------------------------•--=------------ ---------------=------- ---------------------------------- Y K _ I l t ` ! `+- I l ! hereby certify that I have prepared this application and that the work:will be done in accordance with San Joaquin County t ordinances, Ss d rules and regulations of the San Joaquin Local Health District. a [signed} ------ ------� y----- ----- ----- ----------- ---- (Owner and/or Cahtractor) ---------- A-1 --------------� _ -. •-- _ .:. [Title}_ ----------------------- y: - = 1 ------------------=----------------=--------------- - [Plot plan, showing size of lot, location of system inelatianrto rells,::building's;.etc., tan•be placed on reverse side} � ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _ - `�I�• --- ---------------------------------------- DATE-1--- � � ��`�-------------- - 4 R REVIEWEDBY------------------------------------ k`I ='= ---------------- ----- DATE - ------------------------------------------ - �"! BUILDING PERMIT ISSUED---'---------------------- --- � -------------------- DATE - --------- Alterations and/or:recommendations:--------------- - ---------------------- ------;- --------- -----------------------•-----------------------•--------------------------------------- .�. ---------------=- --------------- -------------- ------------------------ ----- ---------- w,_.�.. r.,_. _ _. __.. -- - -- ---------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- t 3 ----- •--- - - fINAL INSP --------- ------- Date_ '� ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205`West 91h Street Stockton,California Lodi,California ti Manteca,California Tracy,California ti