17303 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: `-se 'm h 4 --------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. ..�..._ __3 ; -------------------------------------------------------- .. ---------------------------------------- - --- ------ (Complete in Duplicate), .t . ;. - ;• -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. ' JOB ADDRESS AND LOCATION___..-3 --_____-.�.'.` _ --------- f Owner's Name------- - ---- - ---• -'. -_ - -----• -• -------- _---..-----------------`---- -------------------------'----------------- Ph ----------------------------- ----------- - ------ --. ------ , Phone Address----- _ Phone �� -----------� ... Contractors Name---- :.�, . �. ---- ---- - _,7? 4-- , Installation will serve: 1,Residence Apartment House ❑ Commercial ❑ - Trailer Court ❑ Motel ❑ Other ❑ Number of,livin� units: Number of bedrooms+... Number of baths _I__ Lot size ___ �'� ��- - Water Supply:1 Public;system ❑ Community system"El Private Depth to Water Table..$70ft. Character of soil to a depth of 3 feet: S d ❑ Gravel ❑ San y Loam ❑ Clay Loa TX Clay ❑ Adobe❑. Hardpan ❑ Previous Application Made: (If yes,date...-----------------.) 'No ❑ New,Construction: Yes ❑ N.OX FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " Nti se' file tank`or cess ool ermined if.; ublic-sewer`_is vailable.within 200 feet. It Se tic Tanks Di."stance- from riearest well-----------------Distance from foundation_-_.-.-__........Material------ -------- -- No. of,compartmerits Size----------------------------•--.Liquid depth----------------------=--'Capacity----------------------- ! .:: - Dis os_ Field: : Distance from nearest well---------------- Distance from foundation_._........__f......Distance to nearest lot line----------------- - Number of lines-----------------------------------Length of each line------------------------------Width ofatre.nch --- W I Type-of-filter,material___..---__-__-----_....Depth of.filter. material-------.--------......Total length_._: `tr'+�. ...,..� _ ----------- r Seepage Pit: Distance to nearest wel/_60-.-� Distance f m-f ndation. +...Dis ay�ce to nearest lot line_____, «.., .. ---------- Cesspool; of pits-.----/......:......Lining material-..: °_.Size: Diameter. --------.'---.Depth---- �...__ 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-------=---r ---------- ------------ ----- I------- = - j f J � - Remodeling and/or repairingIdeseribel--------------------------4--------------_-------------------= p 1 a =_ ---------------------------------------" -----•-------•-------------------•---------------;..-------------------------------- --------------------- ----- ----------------- 1 = - ------------- t - = --------•-- -----------------------•--------------------- ---- ---------------. --------- ---------- t I -------------------------------------=----------------------->---•-------------=-----------------------------•-----------------.-----------------------------------------------------:- I hereby certify that I have prepared this application and #hat the work will be done in accordance with San.Joaquin County ordinances tate laws, and r s and regulations of the San Joaquin'Local Health District. 1 l (Signed)- t-------- -- --• ---------------------_ - Owner er a�nor# on rac t or ' { ile) 1ocb -fa-wl ui`Po 'ps ` aERf`systm-in-relation ings,=etc, can-6e---placed-on-reverse-side) �- FOR DEPARTMENT USE ONLY. : APPLICATION ACCEPTED BY--- f -----------------=----------------- DATE...... ----------- ------- -1 ------ ----------- REVIEWEDBY------------=------------------------ --- -------------------- --------------------------- :----------------- -------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------- ---------------=--------'---- --=----------=-=------------------------------• DATE------------------------------------------------------------ Alter ations -----------------------------•--------Alterations and/or recommendations:------ --------------------------=------------------------------------------------- ----------•- ------------- ----------------------•---------•- ----/--�--�-----,-�------•------------ - - ---- ------- {�----t------- ----- ,yam f% _ --------------------------------•---- •------ -- ----------------=------------------------------------------ --------------------------------------------------------------------------------------------- ;I - l FINAL INSPECTION BY:. - ---------- -- - / SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hoxelton Ave.; 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California ( Lodi,California Manteca,California Tracy,California r C5 9 REVMEC 0-$9 3M 3-'63 F.F.CQ.