17331 - Laserfiche WebLink

Home Browse Search

R FORaOFFICE USE: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .-I_�.3-.�1, . (Complete in Duplicate) IZ --------------------- -------------------------------- --- This Permit Expires S Year From Date Issued Date Issued ______ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th wprk hereintscr e This application is made..in compliance with County Ordinance No. S49. s" •E �'a /'', JOB ADDRESS AND LOCATION._ 61t,_/"�«' - '- :- Owne"r's Name _= =' = /f = - ------ -= - - Phone Address-----------------I..Kj;1616-11-� - ---------------- ---------------------------------- ----------- -------------- -Contractor's Name----------- .Z---- -•-----------------------------------1- •----------------- ----------•- - Pho ne- --0 ------- Installation Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: .)-_--- Number of bedrooms __Number of baths /___,Lot size ----- ---------------------------- Wafer Supply: Public system ❑ Community system ❑ Private " Depth.to Water Table r` . ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--- ----------t..t) No� New Construction: Yeso No ❑ FHA/VA: Yes ❑ No� t ��;.�•.• t i- - ,,.TYPE-OF INSTALLATION.AND.SPECIFICATIQN5:;_— (No septic tank or cesspool permitted if public sewer is available within`200 feet.) �- P Septic Tank: Distance from nearest well__�g f__Distance from foug/dation------ _rr�r___..Materi I_.t! ___ i-- No. of compartments-------------- ------------ Liquid de th- _' - .. --------Capacity....�_G�r . Disposal Fi Id- Distance from nearest well..�`.? _�_-_Distance from fonod ::Z _ --__-_Distance to nearest lot �_..- t �s :Width of trench------- ��----------- C(I rA Number of lines .._.____ -c_______ ______ Length of each line__.._____ Type of.f•:lter. material_ ______ _ Depth.af.filter material-------1 __.._-Total length............. ___4_.-_---- Seepage Pit: Distance to nearest well------------------ --Distance from foundation---- to dearest lot 111-P-:---------- V ❑ Number of pits----------------------Lining material'---------.---- --- Size: ----------------------- -----3--------------------- � -� Cesspool: Distance from nearest well_________ _______Distance from fo�'undation..-.---------'_.__..Lining material----.------ _-.--_:__------------- ea ❑ Size: Die f omr nearest well. -� �De fir. ;;;� �:R`' Liquid Capacity gals. �C I " D s a ------ Privy: :_' Distance from nearest building------------------------•---------------- Distance to nearest lot line --------------------------------------------- ----------••-•-------------------------------- -------------------- Yz ❑ _ " r .t Remodeling and/or repairing (d escribe):_______ r_ --e C.:__:rCi1 - 'c h o I ------------------------------ 1 F -------------------------------------------- ----------- •-------- •------------ .,, I I -, t - -----------•------------------------•--------------------------------"-`--- ----------------------------------------------------------------- I hereby certify that I }iaveAprt pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and1rules and regulations of the San Joaquin Local Health District. I (Signed)---------------------- � '`G�! - ra = ' ---------------------------------------- ---------------------- -------------- (Owner and/or Contractor] �. .-;: $y= `.....-----:�--------- —{ ] �� T.= (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can,be placed.on reverse side). r FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY-----�itF 0----------- ------------ ---- i- ------- ------------------ "DATE---=----- ---17--4; .. I = - = `�` ° = `` :__ ---•------------------------------------ ------------- DATE BUILDING PERMIT ISSUE _ I REVI ---------------- t 1 = "= DATE 1--------------------------------- on; " ISSUED------------------------ .;:;;------------------------ --- - ---------•- -- Alterations and/or recommendations:__-. /4C1 __.__ {} 1= - --------5N_DK-T_-_.-- -----------230-7----------------------- - - -------- ----• '0----------- ---------------- -� --- -- - ------------- ---- -------- -- --- ------------------.--.---.--.--.--.-.--.--0-------4-- - ----------------- -------- ----------------------------------------- --- "--- ------- - ------ -- ----- - ------ --- , FINAL INSPECTIO ----- - i Date ' ----- -- l SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVt6ED B-59 31A 3-'63 F.P.E0- 1'