68-64 - Laserfiche WebLink

Home Browse Search

FOUR OFFICE USE: ___------------- -_ -. --I____- ___.___--.._ APPLICATION FOR SANITATION PERMIT Permit No. (o... ---- - ---- 4 1 1 ---- (Complete in Duplicate) ` .._. .-----.--.-. ..-.--------------- This Permit Expires 1 Year From Date Issued ' 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 withCountyOrdinance No. 549. JOB ADDRESS AND LOCATION -I"T o ------ t 1 �� -------- -----R� M� s------------------------------- - fit'- q-----.-.- Owner's Name--•--------•-•--.. &.�LON-••--•---------- —��------' --- - Phone_ __ 7Z�Z_ Address.------------------�.1 - ----------_-----/quSTI-N----------------- ----------------------------------- Contractor's Name------ -------------------------------- -------------- ----- ----------------------------------------------- Phone............-----------------_--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer. ZMotel ❑ Other ❑ Number of living units: __ _l__ Number of bedrooms I----- Number of baths---/-' Lot size ._-./-,cf_"6_�� Water Supply: Public system ❑ Community system ❑ Private U9--15`e"pth to Water Table A ft P @9--Gravel No Y O.w Character of soil to a depth of 3 feet Sand ravel Sand Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yd's,dote.:------------------ ® New Construction: Yes ❑ No B-�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,\ Septic Ta Distance from nearest well__.-,50--._Distance from foundation-----/0.-------.Maters I _CIQAK E'T�_______- No. of compartments--------2-- Size__jV-X.1_qY5�7_Liquid depth-_._. Z_._- Capacity._)_2-T�P_Q._ Disposal Field: Distance from nearest well.-5_4'-�-----Distance from foundation---/Q_...._...Distance to nearest lot line__5 Number of lines---------/--------------------Length of each line_ _____/400 _k_._.Width of trench--------- -1----------- Type of filter material----RQ J!�__Depth of filter material---.._.___�__ _-------.Total length..........1QQ______________________ Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line................. ❑ Number, of pits-----------------_---Lining material--------------------- Size: Diameter.-----------------------Depth_.........___.--•-•------------- Cesspool: Distance from nearest well ________________Distance from foundation----------------- -.Lining material_.----------------------------------- F-1 -_ __._._-._-.-.____.--__________❑ Size: Diameter- -- -------------- ----------------Depth------------ ----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----.-------------------------------------------Distance from nearest building__________________________________________ ❑ Distance to nearest lot line Remodeling and/or repairing (describe):--------------------------------- -1-1------------------------------------------------------------------------------------------------------ ----------------------------------------------------- -------•------------ ------------------------------------------I--------------------------------------------------------------------------•---------------------------------------------•------------------ ---------------- -----------------------I--------------- ------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------••-------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)---IAI- -------co---------------------- ----------------------- ------------------- ---------------------- -------------(Owner- and/or Contractor) BY:-------------------- ------- ------- ----- ---- ------------------------ ------- - - ---- ------- ----(Title)--- --- ------ ------------------------ - ------------- (Plot - ---------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -- --1 ----- APPLICATION ACCEPTED BY--- T �-Q---------- ----------------- - ----- -------------- DATE---------�'"----�Z---- �REVIEWED BY BY------ -------------------------------------- -_---------------..--------------- ------------------ ------------------------ DATE------------_-------- ------------- BUILDINGPERMIT ISSUED---------- --------------------------------------------------------- --------- DATE----------- ------------------------------•------------- Alterations and/or recommendations:.------- ------------- ---------------------------------------------------------_•--------_-- ------------------------------------------------------- -------- ------------------------ - - - - - ----------------------------------------- Date--------------------INSP BY: ___ _ _ Date:- .--..____:_._:_ �z ' 6,e SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press