Laserfiche WebLink
FOR OFFICEVSE. <br /> APPLICATION MR SANITATION PERMIT Permit <br /> ---------- ------- ---------------- --------------- <br /> (Complete in Duplicate) <br />---------------------- ------------ --- --------------9 j This Permit Expires 1 Year From Date issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with CounV Ordinance No. 549.,,V_�h <br /> AU <br /> JOB ADDRESS AI�lj_1OC/%TION_ f ---- ------ <br /> ----------------------------------------------------- ------------------------------------ <br /> Owner's Name. ....... Phone <br /> Address......6 ........ ......... -------------------------------------------------------------------------------------•............................... <br /> Contractor's Name............:/0....................ee......- -------------------------------------I-------------------------.............. Phone.........----- •--------------•-- <br /> Installation <br /> ---------------_Installation will serve: ResidenZeApartment House E] Commercial [-] Trailer Court Cj Motel 0 Other ❑ <br /> Number of living units: Number of bedrooms __Z�__ umber of baths /______ Lot size ------Xl-�V-7--------------------­-- <br /> Water Supply: Public system Community system C3 Private &—Depth to Water Table wro ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] San 4 Loam E] Clay Loam E] Cla Adobe C] Hardpan C] <br /> Previous Application Made: (If iyes,dote--------------------) No. New Construction: Yes o E] FHA/VA, Yes D No E�` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> if public sewer is available within 200 feet.) <br /> (No septic tank or cesspool permitted i <br /> Sp� fi T k: Distance from nearest well./0__`1._D'istancs from foundation---/.. .......... <br /> 1� <br /> No. of compartments_____ _---------Size------- Liquid clepth---- -----------Capaci ---- ----------------- <br /> ��l�a <br /> 0 El <br /> Disposal, eld: Distance from nearest well/6-0-_-Disfance from foundation- -----Distance to nearest lot ...... <br /> trench_..__._.___E3111, Number of hines-- ------------I------------------Length of each line____.__--_--!��W­/-------Width of - ................ <br /> Type of filter material -F?_(f�-------Depth of filter �naterial-_/4-"'r---------Total length------- ---------------------- <br /> See Distance to nearest well-,). -___-__Distance from foundation.../_iQ_./.___-Distance to nearest lot ...... <br /> pag <br /> Number of pits--•---j--------------Lining ma jc_je`____-Sii;ie:' Diameter---3.3. '______.Depth-----Z,--, 2 -_----------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation--- ----------------Lining material___-____-__________-________-__--.... <br /> ❑ <br /> aterial--------------------------------- <br /> El Size- Diameter--------------------------------------Depth--------------------- •----------------------------Liquid Capacity..-------------------_..____gals. <br /> � - ------ <br /> Privy: Distance fro m nearest well-------------------------- -------------Distance from nearest building_____--_,_--_________________-___-____-__. <br /> ❑ <br /> uilding------ ----------------------------------- <br /> F1 -Distance to nearest lot line-------------- -•------`----------------------- ------------ ----------------------------------------------------------------------- <br /> Remodeling and/or repairing describe):--------------- ---- 6_1e�--------- ---------------- ------------------_----- <br /> ---------------------------------------------------l•---------•---------------------------------------I -----------------------•-----------------•-• --------------------------------------------------- ----------- <br /> -------------*--------------------------------------*----------- <br /> ------------------ ------------ <br /> --------------- --------------- -------------- :-•---------------•-•-----------------------•--------- <br /> ----------------------------------------------------.................----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1 <br /> ---------------------4------------ <br /> I hereby certify fhat-L,)have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws an rules egulaflons of the San J6aquin Local Health District. <br /> {Signed]... ---- ---- --- ------------- - ----------------------------- iowner d/o Contractor) <br /> ------ ....... <br /> y:---------------------- (Title)------ -------------------- <br /> B .... .. . i_____�X - <br /> --------------------------- <br /> (Plot plan, showing of lot, ocaflort system in relation uildings,'e+c., can, be placed on reverse side). <br /> V <br /> 11 FOR DEPARTMENT USE ONLY' <br /> ;7q_ <br /> APPLICATION ACCEPTED B�'___j- ----- ----—--------------------I---------------------------- DATE---- <br /> BY-------------------------- ----------- ----------------- ---------------------------------------- ------------ DATE------------------------------------------------------------ <br /> . ---- -------------____-------------------------------------- <br /> BUILDING PERMIT ISSUED---- ----------------------------------- --------------- ------------ <br /> DATE <br /> 4 erati ns and/or recommendations:_- qRTAJLN--MAILI!!��ADDR13SS--BliFDRE--FI ----------------A....------------------------------------- <br /> ------------ .............. ----- ---4�_�e.xk .........�.r ------------------------------------ <br /> 70 <br /> ----------------------------------------------------------I...... ---------------------------- ----------- <br /> ------------------------- ----------------------------­---------I------------------------------------ <br /> ---1-1----------------------------1-1------------!I---------------------------------- -------------------------------------------------------------------------------------- -_-------------------------- ................. <br /> ----------- ----------------------------­......­il-------I------------------------------------- -------------------------- -------------------------------------------------------I------------- --------------------- <br /> .. 'q7 -612--------- -------------------------- <br /> .............. Date. <br /> FINAL INSPECTION BY:.---D-..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street r y <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVISSO G-59 2M 5-61 AILAS <br />