17096 - Laserfiche WebLink

Home Browse Search

OR OFFICE USE: ----_-_2-,- �__-__._ APPLICATION FOR SANITATION PERMIT Permit No. -. - .1.. , ` ....... ........._ 9� .__ {Complete in Duplicate) Date issued ._.... ..�. C .y This Permit Expires 1 Year From Date Issue 0S�9 T Application is hereby,made to the San Joaquin Local Health District for a permit to construct and install the work herein described. # This ap lication.is-made,in compliance w tjh County Ordinance No. 549. �/�lTCGSC>/ �- - 1 JOB ADDRESS AND LOC TIO �T= 4�o!i`_%_ � S Tll�1f: �/�7 -��iC' dr------ ----- _ Owner's Name---------- ,` ----- Phone_ _ J i Address. _._'Z '..------`-3 T - Contractor's Name----- - -- ------- - ---.._. Phone- _ �� "1 I � Installation will serve: ;Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---_ Number of bedrooms ---4= Number of baths .1----- Lot,size ---__---_---------------------- Water Supply: Public�-sysfem ❑ Community system ❑ Private X Depth to Water Table _94'- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,' Hardpan ❑ - Previous Application Made: (If yes Nate________.._--_---) No �f New Construction: Yes ❑ No FHA/VA: Yes E] No,® TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material----------__._.___..__.._.._._____.___.__._.... ❑ Disposal Field: Distance compartments stance f omnea est welL_/ Size .. :.__Liquid depth_..__-._____.. .___...___Capacity____.__._______._______ I p �t r stance from foundation--...'',ami-'._..._Distance to nearest lot line--c,l-_r-------- ® Number of lines---------------- of each line----------�A----------.Width of trench----------�5K.y----`.----- 1 1 CaW _Type of filter material_---jam .Z!A_1___Depth of filter material---_---_,/ _____Total length----------------------�,0--_-------- �6 Seepage Pit: Distance to nearest well------ftp......Distance from foundation_____`_--.Distance to nearest lot line__._�'S._ r 1 - , _ r �.-- . , t 0 Number of pits-s----/------------Lining matena!__�'��-�----Size: Diameter------ �—:.Qepth-----------��5-----........ S ( Cesspool: Distance D ameter nearest welL___�_'--------Distance from foundation____---------------Lining material---,._--___.--.-----_---.-----.-----_ p ❑ I 1------------.- Depth------------------------ Privy: Liquid Capacity = gals_�„ .1 ----------------Distance from nearest buildin #________ ---- ' Privy:' Distance from:-nearest well__�`__._:...__.__...__._-_-_. ❑ Distance to nea�est:]of line---------------------------- ----- --------- i1 Remodeling and/or repairing (describe))------------- ----------------------•------- ':'------------------------� -_-_ -----.-_-----_-__________.__. ___.__j_________._______..__..._...._____ -----_-_--__ # -------------------------------------------------_-------------------•----------------:---------------- = ----------------•-------------------------------------------------------------------------- - 1 k 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 Districf. � I i -------------------- (Signed) ------------------------------------------------- ---------- (Ow er and/or Contractor) ------------------ - - ------- Title -•-�•�--X22•----- ---; ------------------------------------- (Plot - --- -----------.... ....(Plot plan, showing size of lot,.location of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY----- ------ ------ ------------------------------------ DATE--- — �— ---L ---------------- REVIEWEDBY----------------- ----------------------°--=------------------------------ •----------------------- DATE------------- --------------------------------------------- BUILDINGPERMIT ISSUED-- -----------------1-_-----'------- --------------------------------------------. _ ------------ DATE------ :- •----------------€------------------------------- Alterations and/or recommendations:--_ .= ^fes_ .__c`*`�` f- --------- Y E _ -----------•-------------------��- / �t — F��'- - °a`yr= = ,��s ; -----------•----------------------------------------------- ------------------------------ ------- ------------ -------- - -,-- -- -�--- i r ----------------------------------- `-�-- - -------------------------------------- ------- ------------- -- ---- --- '-------------------- ---- --- -------------- -------- ------------------------------------------- FINAL INSPECTION BY:..--- G - Dafie AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. t ------ r 0 West Oak Street 124 Sycamore Street 205 West 9th Street :'Stockton,California Lodi,California Manteca,California Tracy,California E6,9,REVISE G 8-59 3M 3-'63 F.P.CO. I