16667 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; - - -� ' ------------------- -- ------------------------------- -- ----------- --------------------------------------------- ---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _J : -------------- ' (Complete in Duplicate) Date Issued ____L _- `�_-�' - ------------------------=------------------------------- This Permit Expires I Year From Date Issued d SS_r��_!�0 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 compliancewithCounty Ordinance No. 549. l - / JOB ADDRESS AN L ATlO �- $12 ___ [ Z �!7zZ I � !l i Owners Name '-'?'� P ` --------------- . --------- Phone Address = --- ---------------------------------------------------- . rz 1 -----------------•-----•- •-•-•-------------•t Contractor's Name--- -----• �, _.. E - -t ---------- Phone----------------------------------- � . t Installation will serve: Residence ❑ Apartment H use E] Commercial F] Trailer Court F] Motel p Other [I7_l-_ 1 i -Number of living units: ___)__.Number of bedrooms _-�____ Number f baths __�___ Lot size _ ________i__ Water Supply: Public system ❑ Lommunity system ❑ Private 'Depth to Water Table ________ ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes No 0 FHA VA: Yes No TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) 4 Septic-Tank: Distance from nearest well��--_---- Distanced from foundation----la_------- Materia------ No --___ ________________________ No. of com artments.----- __-- �' ---,Y- .---Liquid depth--------�. --- Capacity p �---------._Size_ ----..Ca acit _.-- Dispos reId; Distance from nearest well.._.__'$U_�--Distance from foundation.-_____ U_1._..Distance to nearest lot line_e�_ ____. Number of lines____________/ Length of each line___._--/_ 4__�._____-__Width of trench.__-..� _�-------------- W �e Type of filter materralt_ %__._______Depth' of filter material---- length________IUU-----__, - (r Seepage Pit: Distance to nearest well__-------------------Distance from foundation----------..........Distance to nearest lot line-----__________-_ ❑ Number of pits---°------------------Lining material-----------------------Size; Diameter------------------------Depth...._---------------------------- r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material -.-.____________-_.________--_____:-. ❑ Size: Diameter---- ----------------- -------------.Depth-----------------------------------------------•----Liquid Capacity--------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------.----------- ❑ Distance to nearest lot line------------------ --------- Remodeling -------Remodeling and/or repairing {describe)---------- -------------------------------------------••----------------------------------------- ------r-------- = t ----------------------------=---------------------- --------------•-----------------------------•-- ---------------------------------••--------------------------------------------------------------------------- P E ! hereby'tertify haul have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 'w , and rales anegulations of the San Joaqu'n Local Health District. -------' �c (Signed --------------- e dyor Contractors f By:___ `• - `---:---'----- - - -------- -----' ----- -- --- ---------------------------(Title)---------------- ---------------------- - (Plot flan, showing.size of to s_location-of system in relatio o wells,`6itiidings, etc.;canTbe-placed-on-reverse=side).- FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED $Ya�------------------------------------------------------------ DATE.`_>-_"3-n ! --------------------------- REVIEWEDBY------------------------ ------------------------------------------- ------------------------------------------------------.--DATE-------------------= BUILDING PERMIT•ISSUED=_------------ ------ --'-- _ --- ------ --------------------::--- ---------------------- DATE------ ----------------------- Alterations and/or recommendations: ._ - A, -------- -------- ------------------- - -----------------"------f �----------- -•---------••----••-•---------•----•--•-•-------=-----=----------- ------------- - 1% ,. -------------_----------------------------------------------------------------_------------------------------.----------...--------------------------------------•---____.-_---.______________-__-.__.._-_-_-_______________._ ------------__--------------------_-------------------------------_--------------------------------------------------------------_____.__.___•__.______-_________ _ ----------------------------------- ------------------- T i ----_ _ ___.._..______--..__.______-..___,_----_.______.____.__________--.-_-__..._____ --.---_-_____..-____-._.-_____.._---..-____.____._-__.___ ._.______ - ------- Date. e FINAL INSPECTION BY:-!�/ice- .� 3f _. -/-- SAN JOAQUIN LOCAL HEALTH DISTRfCT 1601 E.Haxellon Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California,~ ES 9 REVISED 8-59 3M 3•'63 F.R-C D.