14045 - Laserfiche WebLink

Home Browse Search

�_-R of 3 E��_..-.�__.�,. � G z' � � , � �' �x a ' APPLICATION FOR SANITATION PERMIT Permit No. ............ .... ------------------- --- ------- ----- -- - - -- This Permit Expires es Com lata in Duplicate) n 1 Year From Date Issued Date Issued .................•..._ I Application is hereby made to the San Joaquin Local Health District for a permit to construct and in4all the work herein described. This application is made in compliance with Cowl Ordinance No. 5499.. a JOB ADDRESS AND LOCATION--- - o.._.. ...•-. . ': = , Owner's Name_ ---•----------- ------- Ptio e -----•--•--------------------•--. .... Address ... -----••--.--------------------------•--•-•--•-•--.--...._----- .; F J �t`o-^ ContractorsName...--- ...........I• -----------------------•-------.-_-------------•--•--.......-------•-------_-------.---- Phone........................ Installation will serve: Residence [�jApartment House ❑ Commercial E] Trailer Court C] Motel E] Other ❑ Number of living units: .--t--- Number of bedrooms __. Number of baths __ __. Lot size _x_�dv -----------------_____......... . l Water Supply: Public system 9 _ GOmmunity system ❑ Private ❑ Depth to Water Table ______._ ft. ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam Clay Loam Clog E] Adobe[n--Hardpan C1 ' Previous Applicafion Made: llf yes,date._____-___..______-) No T�New ❑ C]Construction: Yes Er No ❑ FHA/VA: Yes ❑ No [lam TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' Tank. Distance from nearest well---------------- Distance from foundation--------------- .'Mafferial............................................ YNo. of compartments------- ------------------Size--------------------------------Liquid depth-r -----------------Capacity....................... Disp sal Fiel Distance from nearest well_________________Distance from foundation____..._..__.....__.Distance to nearest lot line____•__----_----- � � Number of lines------------------- ------Length of each line_-•--•---------------.......Width of trench---- .....--••--... ............. i Type of filter material-------------------------Depth of filter material-------------_--------- _Total length____-___________-----------......_...__-. Seep ge P• . Distance to nearest well��.____Distancenfou ation___10.e . Distance to nearest lot line___4_�.._.. Number of pits-------/-----------Lining material----- _ __.Size: DiameterDepth-----j-:2--�>7'/------------- � � Cesspool: Distance from nearest well-----------------Distance from foundation___.-.--------------Lining material.----------------.______________-___- ' ❑ Size: Diameter----------------- --------- ----------Depth------------------------------.---------------------Liquid Capacity----------------------------gals. LA Privy: Distance from nearest well------------------------------------ -------Distance from nearest building______.__-._..-..__..--_-._____._______- ❑ Distance to nearest lot line------------------------- -------------------------------•------------------------------••---------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------- ----•---•-----------------•-------------------•-•----•--•--------•--------•-••-•----------------- _..---•-------- I. ------- --•------ I' I ----•----------- -------------------------------------------------------•--- --•-•----------. --------------••--------------------------•--................ I I hereby certify that I have prepared t ' application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and"regu t' ns the San aquin Local Health District. (Signed)--------•--•....................... ... ............- ---------------- -------------------------•-----------------------------------------------.(Owner and/or Contractor) By:------------------------------ --------- - -----•-------------- -------o- ---------------(Title)--------------------------------------------- --- -------------- ,(Pliot plan, showing size of lt, ocafion system in rel tion to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY Jon r APPLICATION ACCEPTED BY-----r- _L------ ----------------------------------------------------- DATE------:5__---2_ 7----".-- &---: REVIEWEDBY--------------------------------------------- -----------------------------------------------------------------------. DATE---- --•-------------------------------------------..------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE_..................--------------..-...................... Alterations and/or recornm cations--------------- -----,------------------------....- ------- --------- ------------.--- - or .....................................................-.....------------._---------------------------------------------------------------------__ ---------------------------------._______.___..._.-.._...-_-_..__._ I ------------ -----------.................»-------------..---------------------------------------------------------------------------------------------------.»..,.___.---------------------------------------------------------------- FINAL _.__..__FINAL INSPECTION BY:- n------Q - - ----------------- Date------ 7 ......(0.7 --------------------------•--- t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerlcan Street 300 West Oak Street 124 Sycamore Street { 205 West 91h Strut Stockton,California Lodi,California Manteca,California ' Tracy,California rS 9 R[V1590 V-59 2M 5-61 ATLAS -