16961 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i } =s Permit No. _-_...................�� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) . Date Issued -----------••---.. This Permit Expires 1 Year From Date lssued. Application is hereby made to the San Joaquin Local Heal h District for a permit to construct and instal;the work herein described. This application is made in compliance4ith County Ordi n No. 549. , ;r t - = -----•--------- --------------------- JOB ADDRESS AND. T10N. _ __-- t Phon --- - �1 ----------------------------------- - Owner's Name----------- - --- -- -- ----------- _ I; Address_--__ ------- t C Ott; Phone 11 E Contractor's Nam '--'—---- �partmenf ' Other ❑ Installation will serve: Residence House 4 Commerc, I ❑ Trailer Cour Motel ❑ e i �� _" tot size --------/-J ----- ------ Number ----j Number of living units: :____ Nu ,ber of bedrooms ------"- Number of baths .- __ l _ Depth to Water Table '�ft. Private ❑ p Water Supply: Public system Community system ❑ Adobe 8--HHardpan ❑ I soil to a depth of 3 feet: Sand ❑ Gravel- ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ U Character of p. A/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date--------r--:. -- ..y No [I:'- TYPE _ New Construction: Yes ❑ No �. TYPE OF INSTALLATION AND SPECIFICATIONS: ' .` r (No se tic t or cesspool permi#ed if publicsewer is available within 20U feet.] l - nk: Distance from nearest well -' -- --Distance from foundation-"----.--_---_----.Material---._--_.---.-._-"--___- "-------------------- Li uld de th Capacity---------------------�-1 (g j r' No. of compartments Size -------------------- q F?. ce from ne rest we;-----------------Distance from fouridaion-_."---------------Distance to nearest lot line--------------- } oral eld: _ ` Number of lines- ---___--_------------ -----Length of each line =--------- .Width n trench--------------."---------=---- _.( 1 Type of filter material_---"--------------------Depth of filter materia;-------------------P-Total length------------------------------------•--� k "f Distancerom foundation - Dista e to nearest lot line---"_ ---- Q -, �� n Seepage .Pit: -s-Distance to nearest well-- -- g- _.Size: Diameter ------ Dept'n---Z. ---- ,�t- fining material _ N------- , lumber.of pits- --4- ----"- ' Cesspool. - Dist nce from nearest well-- ----------M;t nceT,f5€��ndatiori----------- -Li�nuid Caing pacity ---- -----:...gal s. � i ❑ � «.,.. 5ize:)'Di,mete r.4 ----- p - , I Distance from nearest buildi n�__�---------------------------- -----� � Privy: Distance from nearest well"- '------------ - ---------- est Distance to nearest lot fine`_.----------------------- -------------------------------------- -- I Remodeling and/or repairing (describe): --- -- - IN-------------------------------------------- ----- - -------- --- -- - - ---- -- y --------------------------------------------------------: _ - ------------------------------- ! hereby c •fy that I have prepared this application and that the work will be done in ccordance with San Joaquin County Joaquin Loc f ealth Di t ordinances, a law nd rules and r ulation f t S n Joa \ r 4 _ > Co ct d`' n ra or]' I ---- (Signed)- l (Title) y ----------------------- BY:---------------------'" -- - buildings, a ., can be placed on reverse side]. i (Plot plan, showing size of lot, location of s stem in relation to Is, FOR DEPARTMENT USE ONLY p =� - --------------------- DATE------ APPLICATION ACCEPTED BY DATE------------------------"---------------------- -----------' REVIEWED BY = - - DAfE I BUILDING PERMIT ISSUED------------------ --------------------------- Alterations and/or recommendations:------- ----------------- ---------------------------------------- ------------------------------- !�Y-.- ---- a �� -----•-- -------•- rti—( ------------------------ - -------------------- -----� -t�-G�'----� --- --- ------ - ._ --------------- ------ _...max._" -------- ------------------ '- --- --� ---- -------- . --- -G - -------------- --------------------------- FINAL INSPECTION BY------------ ------& ' Date------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazol+on Ave. 300 West Oak Street 124 sycamore Street 205 West 9Th Street r Manteca,California Tracy,California Stockton,California I Lodi,California E5 9 REVISED 9-59 3M 3•'63 F.P.CO.