14240 - Laserfiche WebLink

Home Browse Search

J . 11 FO: OFFICE�SE: .� ...:.............._,____._.__.____..._.-_4_;_a6 APPLICATION FOR SANITATION PERMIT Permit No. ...1.. .?.... ------------------------- ------ ------------------------ (Complete in Duplicated 5/ 21— ------------- This Permit Expires 1 Year From Date Issued Date Issued ......_.� _ Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Cou ty Ordinance No. 549. JOB ADDRESS AND LOCATION_.__ -• •------- ----- /r=_. 61[�c! ------ ?'1---- -- tPr_..-•------------------------------------•-- Owner's0-4-e- -----------------------------------•--••------•------------•--•--- Phone.............---•------•---------• Addressr r-- -------------------------•-•---------------------------••--------------------------------------••--•------....-----------•-----------•-----•- Contractor's Name--------- ---••--••-•----•----------- ----------------------------------•-----------------•--•------- Phone................................ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: -_?.__. Numbed of bedrooms _2-_ Number of-baths /.1 Lot size ... --------------------_- Water ------------------- --Water Supply: Public system R_*"Communi�r system ❑ Private ❑ Depth to Water Table JP ft. Character of soil to a depth of 3 feet: Sand.E3 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ,Hardpan ❑ Previous Application Made: (If yes,date_____-._.`_---------.1 No ET'_ New Construction: Yes ENo ❑ FHA/VA: Yes R�F— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available within 200 fee+.) i 5�ptic Tank: Distance from nearest we ----- -----Distance from foundation o ndation----/A-9------.Material.- - �� No.'of compartments___ _________________Sizes��_. 1��.16quid depth_-_x.`.'.____..________Capacity. Disposal Field: Distance from nearest well---— ------Distance from foundation---Za....___.Distance to nearest lot line... ........... ®� Number of lines......_;�--c...... _ Length of each line.___—P_ _- Width of trench___Z _________________________ Type of filter material._Z----Depth of filter material..__�Q.-��____._Total length_.._/�_C1______ __________ Seepage Pit: Distance to nearest well.___ "._____Distance fr m foundat.ion----,M......__-,Distance to nearest lot li.n.e__. _ � ial. _ Siz : Diameter of pits____ _ : .s _..__.____ R' Cesspool: Distance.from nearest well,_______________Distance from foundation-- --------------Lining material..----------------------------------- Cl Size: Dia meter-----€---------------- -----.Depth-"----------------------r------------------------Liquid Capacity ...... gals. Privy: Distance from nearest well_r-_____------------------- --------------------_Distance from nearest building_____._---__________-_.-___-___________._. ❑ Distance to nearest lot line----------------------------------------•-------•------- _= - i , -- -------------------------------------------- Remodeling and/or repairing Idescrilies:__.__=_____-_ - - ---- ------- ��-------•---------------- ----------------------_--....-•------• , I ............................................................... --------------------------------------------------------------------------------------------------------------------------------------- . I .....................................................-------------------------------------------------------------------------------------------------------------------••-- ----------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and'regulations of the San Joaquin Local Health District. (Signed) - -- --- ------------------•----------------------------( yr Contractor) . F { Br------------------ --•--•---..:�.._.. ' (Title)._ , -i! -.------------------------------- (Plot plan, showing size of lot, location of sys+e relation to wells, buildings,etc., can'be pieced on reverse side). �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- __-'- s ----,----- DATE_....45----- _4._- z---------••-------------- REVIEWEDBY------------------------------------------------------------------------------------------------•--------------------------- DATE I BUILDINGPERMIT ISSUED-- ----------•------------------------------------------------ ----•-----•-------------- DATE.---..__..------•--------------•--- Alterations and/or recommendations:-S---I-4-----�--�------------ - - ----- -h_s. � �_�,.._.-1•-.-- - - -- -- 5 .................C --------------------- r ---------------------- ----------•------- --------------'--•-------------------------------------------------------------------------------------------------- -----------------------------------------------._....---•--- a. ____________________________________________ FINAL INSPECTION BY:. �� i `i------- ----- ------ Date---- -`--- - SAN JOAQUiN LOCALS HEALTH DISTRICT 130 South Amerkan Street 300 Wed Oak Strwt"f 1`. + .k, 1;24 Sycamore?Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy;Califordn�ia EB 9 NEVISEo B-59 ZM 5-61 ATLAS _ "