73-1100 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- ------ -- --- -------------------- ---------- ---- ----- -- ------ ---------- ---------- - --- -- APPLICATION FOR SANITATION PERMIT Permit No. .. r. it Q�. C -------- -------- --•--------------- (Complefe•in Duplicate) - - ----7�-- ._.___-------- ----.... This Permit Expires 1 Year From Date Issued Date Issued la --r--- Application is hereby m6de 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 CCoou�ntt, Or i nce o. 549. JOB ADDRESS AND LOCATION_.. /;` "TJ -------- ,C.[ - - �s-a...� .� Owner's Name. �} •--•-�-=�-- - - Phone.. rf , I Address.._....( - = d ' '� --- Contractor's Name ----------------------•---------------------- Phone.0-�".�r••^-4- Installation will serve: ResidenceApartment House ❑ Commercial E] Trailer Court ❑ Motel E] Other ElNumber of living units: __ _.___ umber of bedrooms ........ Number of baths-------- Lot size -------- ----------------- _-_-_-.---___.---..-----_-.---_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_----- . I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes E. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from r ❑ foundation--------------------Material ------------------------------------------------ No. ----------..._.---- __.._._-_-__._____._!-._'. _.-_.-_- . No. of-com artments_--_.- _------. Size------------- ------ ------ ----Liuid de th--------- ----- Capacity ------- Disposal Field: Distance-from nearest well -_Distance from foundation-----!_ll-_ -------Distance to nearest lot linef_S_---------- Number of lines_ __ __________ _____ !�Length of each line-- - � --------- of � .:--.-.----..- Typegof filter mate riaL_. _ �ta!__Depth of`filter material____.l_ ...._r_.___.Total length____._ .____________:_..___p Seepage Pit: Distance to nearest well__F_ _.t._.:Distance fro foundation__.,.------- Distance to nearest lot lin ,4��-- Number of pits-------/-------. --Lining material-_-d`1' o�--_..... Size: Diameter--_/ V-d- Depth_.1.� X * .Cesspool: Distance from nearest well ----------------Distance from foundation_-_- Lining material--------.---------------------------- r ❑ Size: Diameter. ---- --- - ----------.De th----------------------------------------------------Li uid Capacity p q -- - --------------------gals. Privy:— Distance from nearest well----------- ------ i._-__f-.. _..Distance from nearest building-------.-_-_-_._----.-_--_---__-._-_.-._. Distance to nearest lot line----------------- ---------------------------------------------------------—----------------------------------------------- .---- Remodeling and/or repairing (describe):----- -4-Lel ------'---------------------------------------- ( V } - ---------------------------------------------------------------- ------------ -------- ------------------------------- i 0G 4 ---------•--------------------------------------------------------------------------------------------------- - - ----------------------------------•----- --------------------------------------------------------------------- t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 3 ordinances State laws, and rules and regulations of the San Joaquin Local Health District. 1 (Signed) -z 4 ° '- � Com'---------------.-------_ ----------. Contractor) �!! BY= asysem ----- -- - ------------ ------------------ -----(Title)._.._ 1 . . - - - - .----- -----.----- (Plot plan, showing size of lot, location of in ration to wells, buildings, etc., can be placed o1i reverse side). ' _ ----- ^-- ` '^ —FOR-DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY w DATE_ '` ------------ -- REVIEWEDBY--------------------------------------------- --------------------------------- ------- ------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------- -----------------------------------------------------—-------------------------------------- DATE------------------------------- ----------------------------- Alterations and/or recommendations:--- - ------- . ............... -- - - - -- ---------------------------------------------------------------------- -------------------------------------•------------------------------------------------ -------------------------------------_:------------------------------------------------------------ -------------------------------- ------------- --------------------I------I-- ---- - - ---------- FINAL INSPECTIO Date__.........----- d . SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.Ha=ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi. California Manteca, California Stockton,California Tracy,California E.H.9 2M 1-67 Vanguard Press