18103 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �7 Y --------------------- ' 0 3 APPLICATION FOR SANITATION PERMIT Permit No. ..ldl-------. --.- ------------ ---- ---------------- -------------- [Complete in Duplicate)_..__ _" l . .Date Issued ----------------- _-------------i------------ This Permit Expires 1 Year From Date Issued r 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 compliance with County Ordinance No. S49. ,r rte' :�_C.(^c A ------ JOB ADDRESS AND LOCATION_ ,_y --••----___- F - ----------- --------------------- LCr�t�2 ' �d"Tv ------ ----- - ---------- hon -------------------------- ----•---- Owner s Name -----------•-----------•----------•-•--•---------------••------ +. -------------- _ , _ - Address-----�-�-----r��----•----��7��'f�•-•--•----------------------- �.��•�"" ICS .--- - - ---------------•----•-•--------- �= Contractor's Name------------� ..............•----------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence'g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms __- Number of baths ---I Lot size I Wafter Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table _* ft. ; Character of soil to a depth of 3 feet: :Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe� hardpan El s,dote__________________-) No (A New Construction: Yes E] No E] FHA/VA: Yes E] No Q Previous Application' Made: (if ye TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or cesspool`permitted if public sewer is available within 200 feet.) lMaterial------ ----------------:--------------=---------- Septic ank' Distance from nearest well--- °.."_Distance from foundation___ �� I No. of compartments-- -----------------------Size------•-•--_-------------- - Iquld depth------------------ -------Capacity----------------------- t 1 } n Disposal Field: Distance from negrest well ,_____.__.Distance from foundation. � 7 -iDistance to nearest lot line___________.____ c / ?=(sC5-(a ` ED ,Number of lines- -- -------------Length o each line idth of french__V/'.-::-- -- -----> Type of filter material__:S7"r�p _:Depth of filter material----I_X_______._ g ---Total len th__.-�*_��-- .--:'- �� t Seepage Pit: Distance to nearest well_____________________Distance from foundation-------------------.Distance to nearest lot line----------------- El Number of pit's----------------------Lining material_----------------------Size: Diameter------------...--------Depth__:--.---------------------- --- Cesspool: Distance from4 nearest Well-----------------Distance from foundation...._______---..__.Lining material-------------------------------- --- ',... ❑ Size: Diameter_._ Depth------------------------------------ ---------- Liquid Capacity -----gals. `""'-"D'is'tance #rom nearest buildin �-- Priv =Distance from}nearest well------------------- ------==------ g-------------------- ---" ! ❑ Distance to nearest lot line-------------------------- ------------------------ -----------------------------•---------------------------------------- yy and o re airin describ �✓�`______.__ - ----- --- '�' '"""�'` ---------- Remodeling, ' ----------------------- .� 0p G V I hereby certify that I have Iirepared this application and that-the 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) -------------------------------- ------------------- ---------------------- ------------------------------------------- ________________(Owner and/or Contractor) By:-----------------------------------------------••----------------- -------------------=-- -- ------------------ ------ ------•-[Title)---------------------------------------- ---------- �, .1 (Plot plan, showing size of lot, location of system in relation foo wells, buildings, etc., can be placed on reverse side). [ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. ---------------------------- ----------------- -------------------------- DATE REVIEWEDBY------------------------------ �--------'--- ------------------------------------ BUILDING ---------------------------------- - DATE BUILDINGPERMIT ISSUED----------'----------------------------------------------------------------------•--------------------- DATE-------------:--------- ----------------- - --------------- Alterations and/or recommendations:--------------------------_----------------- -------•---- --------------- -------- ------------------------------------------- ------- -------- r-- �`-E------------------------ '`' - / °�- ; __ •P - �...... ---��,,�•" ---- = ?41! . 11 . ---------- --------- x - FINAL INSPECTION BY:-.------- ---- =- ------ Date_.----- L__Q .:I� / -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. r 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �5 4 nEVI5EO 13-59 3M 3-•63 C.P.CO. ..,