17991 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: ,...:. . ------ �.. . --- ----------- J Permit No_ -----_------------------ - _________ � . --_--------------_---- .-- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ._ ------ ---------- ---------- -------- ----------_-___.-_., —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 compliance with County Ordinance No. 549. �'�` JOS ADDRESS AND LOCATION-1?e,!14-11, Owner's Name - y = Phone------------------------------------ 4- �. A Address - -------- �` { �R• - Contractor's Name--------------- ---------- ------------ Phone____ --------------------------- Instaliation will serve: Residence [''`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ... Number of living units: __/__ Number of bedrooms _,�Z, Number of baths _`___ Lot size /4 ------n-- Water Supply: Public system ,Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel-E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {ff yes,date--------------------) No [--_'New Construction: Yes R`�'No ❑ FHA/VA: Yes W},-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tak- Distance from nearest welL___�-------Distance ram foundation_ ._-Ae9__----M afer' �---------------- No. of compartments------ ---------------Size_x - - -Liquid dep`h----_ ___.��---____Capacity_ Q_ --__--- Disposal Field: Distance from nearest well-___r'_--Distance from foundation...A�__-_.--.Distance to nearest lot line- -------- Number of lines------/-------- ---- --------Length of each line---- ��---------7----.Width of trench-_-------------------------- Type of filter material-�/ eli Delp hof filter material-_-./f._.-_.__Total length------- k�?----------t------------- Seepage Pit: Distance to nearest well-----_ -'__.---Distance fro fou dation___._ � _____Distance to nearest lot lie--- -----------�.W Number of pits----__/_________-_Lining material-_/41 G� Size: Diameter-_ __ Depthy�e �--'�-______________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mater,al------------------.------------------- �1 El Size: Diameter----------------- --------------------Depth Liquid Capacity gas.�J Privy: Distance from nearest well-------------- ---------------------------------Distance from.,jnearest building--------------------------------------_-_. ❑ Distance to nearest lot line------------------------- - - ------------------------------------------------ --------- ------------ ----------------------------------h Remodeling and/or repairing (describe)-------------- — - - --- a --------------------•------------------------------------------------------------------------------------------------- ---- ---- -- ---------------,-------------------•-------------------------------------- -- - -- -__------ --------- - ----------------------------- ---------- '� - ------ _-----------------------_ - - -- --_ - -------- -- ------ -- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County.' ordinances, State laws, and rules and requlation of the San Joaquin Local Health District. (Signed)------------- �or Contractor) --` (Title)-eoefl_c` --------- (Plot plari`showing size pf lot, location of system in rela o o wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY t,r {APPLICATION ACCEPTED BY----Ll - ------------------------- ---------------- ------------------------ DATE------ --------------------------- - REVIEWED BY- ----- ----- DATE------------------------------------------------------------ I , k_BUILDING PERMIT ISSUED------------------ -------------------------------------- --------------------------------------- DATE-------------------------------------------------------------- Alterations and/or recommendations:._S-Z.--�-t�s----6-A-------v�----j s. ±�•'�---`---- �� r ------------------ ----- -- -------------------------------------------------------------- a. ------------------------------------------------ --------------------------------------------------------------------------------------------------------------- Y ------------------------- -------------------- ---------------------- -------- ------- p �,p,�_ ------------------------------ FINAL INSPECTION BY: _...- '`.'` ------------------------------- -- Date- :�_ LI-�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Haxellon Ave. 300 West Oak Street 124 5.ycamore Street 205 West 9th Street C13. f Stockton,California Lodi,California Manteca,CaIiforni"a Tracy,California F.P. I I