19091 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE ---------- --------- ------ �I APPLICATION FOR SANITATION PERMIT Permit No. ./Ie.. _�� ___ --------------------------- ------------------------- r _ . ----- (Complete_in Duplicate). - - d •...,.,..Date Issued ---- t This Permit Expires t Year From Date Issue E Applica4ion 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 compliance with Countyr Ordinance No. 549. i x ; �-r rr JOB ADDRESS AND LOCATION_C d7-•_._ 7 > _ �� - ' ----- a}--------- --------------- 6) GJ -----•• "-------------- - Phone---:...------------- ----- ---- Owner's Na jme�---- r---. d_! --•----- ------------- ----------------- ---------------------- - " Address �' b � - 6-��"� ��-2----�'� - •----••---•-------------------- Contractor's Name---------------• _�_�_=-r:--- ............... _. -----:----- ----------- --------- Phone Phone----------------•-�---------------• .. Installation will serve: Residence Apartment House ❑ C,ommercial ❑ Trailer Court ❑ M+ 1 ❑ Other ❑ Number of living units: __ 'Number of bedrooms :-�___ Number of baths __r__.Lot size,____/h ___:___ /Water Supply: Public system ❑ CommunitY system ❑ Private [� Depth to Water Table ft. i � I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan - �r�_ ❑ No FHA/VA: Yes ❑ No P P rt ! _ previous Application Made: (If yes date._ "" ---.---..---1 No New onstcu ti n:_ es • TYPE.-OF.,INSTALLATION AND SPECIFICATIONS: g (No Opti tank;or cessp oo I p re miffed if public sewer is available within 200 feet.) Se is .. f Distance from nearest well___ ��__.___Distance fro foundation__ J�__�_____--_Materaal_�_- -r _______; ani ' rNo. of compartments_.___.__.-_-2 --Size,' X_ 4��•Z_,eLiquid depth__.,_ ___'Capacity..�_�.__--_-"_____ �^-t 7# H i e� . vjc_____._Distance from foundation-------------------- _--. _ - __'Distance to nearest lot lin '� +l� Disposal Field: Distance from near ' welL__-1-- _ _- Len th of each line" Width vf..trench__ ___- Y' ___ _.________ Number of lines g - ,';�v�.; y. p Type of filter material�-1 _Depth.of filter materia_ f_T._r_/_-Total length--------- 2. Seepage Pit: Distance to nearest well__.-------__- -._____D,istance from foundation------------- Distance to nearest lot line__._________.-. [ ❑ Number of pits.#-------------------Lining material-----------------------Size: Diameter---------------.---.---Depth--------------------------------- Cesspool: Distance from nearest well________________Distance from foundation___________________Lining material---------------.._______.-_________- V. I Size: Diameter- --------------------------------Depth------------------------------ -----------------Liquid Capacity----------------------------gals. �—~Priv '=' '"—Distance' from nearest well._____::__-_-T-------------------------------Dis'tance=from nearest-building------------------- ❑ stance to nearest lot line-------------- - - ----------------------------------------------------------------------------------- - - ------ -- ----•------------ ------------------- -- i mss„ r'liC 1 I I 'Remodeling and/or repairing [descrii�e�:-- / LG �__ ---------------------------------------��-� -- --- i--------- = - --------------------------------- ----- �`z '''�f- MF-� ti-c�cs ------ -----no --- --- -- ------ ------ -------------- = F ----------------------------------- -- ljep r e!'� I -=C�G�r - - --- - - ---------- - -- r I hereby certify that I have prepared this applicatior>✓nd th � the work will be done in accordance with San Joaquin County 9 r ordinances, State law. nld rules )r u atibns of the San Joaquin Local Health District. (OWner and/or Contractor (Signed)__ - --- -- -----------------------------------------------_ _ _ Y� - -----•------------ ------------------------------------- e (Plot plan, showing size of.lot, location of,system in relation to wells, buildings. etc., can be`placed on reverse side). FOR DEPARTMENT USE ONLY --------------------- APPLICATION ACCEPTED BY------ ------------ ----------------- _ -------DATE---- --(---- -- t/ -� ---------- REVIEWEDBY---- ------------------------------------------------------------------- ---------------------- _DATE......----•--- BUILDING PERMIT ISSUED =`------------- ----------------- ------- DATE - Alterationsand/or recommendations---------------- -- -----=------------ ------------------------------------:---------------------------------•-------------•---•--•----------- ----•----------- --------------------------------------_----------------------------------------- ----------------------------- FINAL INSPECTION BY: -= � y� ?------------- Date ---Y---�9 �� - I SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodir California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.CC.