22028 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

- FOR OFFICE USE: Permit erm P ----------- - ----------------------------------------- cz2 I -APPLICATION FOR�SANITATI4N PERMIT No. --- --r�----�- ----- ---------- -------------- -------- --------------- =- - I ----------------------- ----------- (Complete in Duplicate) Date Issued _,Z_--11------- ---------------------------- -- _----- -------- - -_. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in describ d.,� This application is made in compliance with County Ordinance No. 549. 12-13-0 0C// JOB ADDRESS AND LOCATION ._' _ � f'°" �"` r �------Phone- - -Owner's Nameo -------------- V----------------------------------------------- -------------------- Contractor's Name-------- -------------------------------------------------------------- --•--- Phone---------------------------------- Installation will serve: Residence ®/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - t Number of living units: Y--- Number of bedrooms—S-.. Number of baths Z-___ Lot size 1-- - Water Supply: Public system ❑ Community system ❑ Private &�epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [�i Previous Application Made: [If yes,date-___---------------) No 25r New Construction: Yes Zq.-,Mo ❑ FHA/VA: Yes Z;--No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Distance fr foundation_-�`' ! Materta� -ice il�-------------- Septic Tank: Distance from, nearest well__. , - _ = s No. of compartmenfs---- ------------ -Size__ ------- Liquid 'de�h--- '`- ---_._.Capacity/��- Disposal Field: Distance from nearest well_9-0.__..Distance from foundaticn_ZiO-_- 7-D,stance to nearest lot line_A.17____ Number of lines-------A-____ _ _ _ Length of each line_Xep-__.-�___-Width of trench-,.__-___�_-.-_________.____ ----- ._ _Total len th_ Type of filter matenal�-�/.��sDepth of filter matenaL_f-�___`_ g --- --�r�------------- -------- Seepage Pit: Distance to nearest well__ Distance fr fou anon_ ------- ---------- -----------.D staniede to nearest lot iin` �l __._ �/ I -----Linin material_�e. Size: Diameter-, Deptn s ---------- -� Number of pits...p�_---� gQ} Cesspool: Distance from nearest well----___.____.._-Distance from foundation_______________:""Lining material__.__________--------------- ---- !� I ":�❑ Size: Diameter----------------- ------- ----------Depth Liquid FCapacity 9 �n f Privy:, Distance from nearest well-------------------------------------------------Distance from nearest building-------_________._.__--------------------. (� ❑ Distance to nearest lot line------------- --------------------- ----------------------- -------- ---------------------------- ---------------- Remodeling and/or repairing [describe]:----- ---W_5; � --------------------------------------------------------- Y A a I %L f .i k ______________________________________________'______ _____________________________________ ___________________________________________________________________________________________________A,___-_-____-___-_-______________.______.______ ___________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfrict! } 1` (Signed)_ 0�--1 �/�/--� r r Contractor] ------------------- - --- 1 ,, � ---- -------- - ------- By: - .. ----------------------------------------------- = - - ----------- - {Title) (Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side}. E FOR`DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._.. ------------------------------------------- DATE _ _ Q.'f� .----------------------- - REVIEWED BY--------- ---------------------------------- ------------------------------------------------------------------------------ DATE------------------------------------------------------------ - BUILDING PERMIT ISSUED------------- ------- - ------ DATE------------------------------------------------------------- Alterations and/or recommendations----------------------- -------------------------------------------------------- -------•--------- ---- [ --------------- -------•- --------------------- ------------------------------------ ----------- ----------------- FINAL INSPECTION BY:__ -_ __.___ Date__._.___-� - - SAN JOAQUIN LOCAL HEALTH DISTRICT '•` } 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California