13315 - Laserfiche WebLink

Home Browse Search

5 . ._._�..�1..._�S APPLICATION FOR SANITATION PERMIT Permit No. _ (Complete in Duplicate} � / - --- -�-� _ �``. .a Date Issued ----------�{•�� �,3 f GLEE f�r�L)� ,This Permit Expires 1 Year From Date Issued p S�—t 00 --O Z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here's described. m This application is made in compliance with County Ordinance No. 549. 4 ' JOB ADDRESS AND LOCATION-------- IL' ---- t 'a. --- ---- ----- ; eye --7----------------------- Owner's Name ` w... � �&,/Al..-... __1G.�C°��f/ ��J �� Phone Address--- = j` -� -------- �(3 �+--- 1 ...5--. 1 a Phone' ,Q - , Contractor s Name-�-:._...,_� _.----�/----�--•�-�-----��f_.f.'�-.9��, � ---��-•---�-----•--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------- ----- ---------- Water Supply: Public system ❑ Community system ge Private ❑ Depth to Water Table 3.1_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous_Application Made: Yes ❑ No / New Construction: Yes [-] NoFHA/VA: Yes ❑ -No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptjyank: Distance from nearest well-----------------Distance from foundation--_---_----.-_----.Material------------------------------------------------ No. -___--------___-..---- .-_------.--_.____--- �f f No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity..----------�--� Disp s jel Distance from nearest well.-.�_--..._.Distance from foundation�...- -- _ Distance to nearest lot line.�-----._.-.. Number of lines--_ -----_Length of each line-------- _-�`__" Width of trench__.- _f --------------- 1 Type of filter material--__R---e-----Depth of filter material--- ---------.-Total length_-_-- --_ - ` Seepa Pit: Distance to nearest ell__ L�3-0.---___---Distance am foundation-_40__.r._--.Distan to nearest lot line_ --_-�.-- Number of its----- ------------_--Linin material------ _L `_-.Size: Diameter____ -_ t� p• � g '��--------.Depth--- --------------- l Cesspool:" Distance from nearest well-----------------Distance from foundation---------------.---.Lining material-------------------------------------- Z ❑ € . Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. E Privy: Distance from nearest well-- ----------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line---------------------------- ------------------------------ ------ ------------------------- ------------------------------- --------------------------------------- Remodeling and/or repairing (describ ------ ------- i --------------- ----- --------=—.--------------- ----------------------- ---------- --------- ----X------•------- - ---- - ---`---------------------------•--------------•------------------------------ ----------•---------------------------------- ereby certify that I have pared this application and that the work will be done in accordance with San Joaquin County - ordinances, State la and r sand r a io of the San,Joaquin Loc Health District. o Owner and/br Contractorl By:------------- -- ----- Tale -- - - - - ---- (Plot plan, showing size of lot, location of stem'�n relation to wells, buildi gs, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- ------ DATE-------------- --------------------- REVIEWEDBY----------------- --------------------------r------------------------------------- ----------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------------- DATE--------------------------------------- --------------------- > Alterations and/or recommendations:---------------------- -----•----------------------------------------------------------------•-- ------------------------------- f i ------------- „- 1 _1110 I FINAL INSPECTION BY• �-------------- ------------ � - ---------- -� ---------- ---------------------------- SAN ------------- -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 F.F.Co.