19938 - Laserfiche WebLink

Home Browse Search

FOR OFFICE.USE: a } ------------------------------------------- --- ------- --------------------------------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ,1 --------......... , -- - --------------------------------------------------- (Comple+e in Duplicate). r -' Date Issued ----------------------------_----------------F------------ 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 herein described. This application is made in co � itfz„County rdin nce o. 5�9. JOB ADDRESS AND LOCATION'`, --- - ------ Owner's ----Owner's Name_ ------ - ---------------------- *- Alf--l- - - - - - ----`"`-��- Phone-=----------------------------------� Address f / R Contractor's Name_ r f r --- ----- --------------------------------•---------------------- Phone-----------------------•---------- Installation will serve: 'Residencef[ Apartment House ❑ Commercial, ❑ '`-Trailer Court ❑ Motel ❑ Other E]- Number of living units: ___!�_-_ Number of bedrooms _:Number o .baths E_-----.Lot� size _____--.-;:� ___T_.__ +Water Supply: Public system El _.Community system ❑ .Private, epth to Water Table v_. ft. Character of soil to a depth of 3 feet. # Sand ❑ Gravel ❑ Sandy Loam E- Clay Loam ❑ Clay ❑ Adobe❑ Hardpan- C Previous Application Made: (if yes,date-----------_,_.__-_1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ . No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k J t► (No septic tank or cesspool perrni+ted ifpublic sewer is available wi+hin:200 feet.) / -- Septic ank: Distance from nearest well-----------o Distan from ynd tiPn._._f jQ________.Mate�ial_.. ' y �� _S 1� = Liquid depth-------- =-------------Capacity-- �� No. of compartments_.._._ '_____--' }_.._=-Size - ' - j- ----- Disp�/Field: Distance from nearest weil__�@_...1Mstance from foundation___ - -.....__.Distance to nearest lof lined____._-.__... ` Number of lines________ _ Length of,each fine- Width of trench----.�___ Type of filter material---___--- -i_ -_De.pth of filter_mater:aln.-_�_y�___._._s Total.'length----1`d -------------------------- t: Distance to nearest.well___�10_!J_- -__Distance from fbundationZme _Q_ ____.Distance to nearest lot line-- ---------- See/pa , Number of pits---- .._..___Lining material_::__NZIR_r----Size: ter______ r- _-�% _Depth---s2 �____._______._ , Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material_______________________:_____.__. Size: Diameter.------------------------------------Depth--------------------------- ------=-----Liquid Capacity------------------------ ---gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_____________________________..______._._. ❑ Distance to nearest lot line--------------------------------------------------------------- ------------------------------------------------------------------=----- Remodelingand/or repairing .(de cribe):--------- -------------------------------------••---•----------------•---•-•----------•---------•---------------------------------------•--•----•-------- i I 4 a .. ------------------------------------- ------------------=--•--------------------------------------------•--------•--•--------------------------- ----------------------:----•--------------------------------------------- I hereby certif at I have 'prepared this application and that the work will be done in accordance with San Joaquin County f. ordinances, Stat aws/ and rules and regulations of the San Joaquin Local Health District. 4 ---------------------------------------- - and/or Contractor (Signed) I By:----- --- - L --------------------------------------------------------------••----•----------------(Title)----------------------------- --------- ------ - -- --- - (Plot plan, showing.size of lot, lots+ion of syste In relation to wells, buildings, etc., can be placed on reverse side). r 1 FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY ------------------------------------------------------- DATE---- �/ f REVIEWEDBY ------------------------------------------------------------_-----= DATE - BUILDING PERMIT ISSUED t --------------------------------------------------------------------- DATE _ = Alterationsand/or,recommendations------------------------ ---------- -------------------------------------------------------•---------------- ----------------------------- -------- i ,. ------------•----------------------- - ------------------ ---------------- --------------=--------------------------------------------------------•-------------------•----•------------------------------------------------- �� FINAL INSPECTION BY:...... ----- Date.... ------- -----6----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California MonteCar California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.P.CO.