16237 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------------- --------------------------------- ----------------------------------------------- _---__- APPLICATION FOR SANITATION PERMIT Permit No. __•/ .. ,Qf--------------------------------------------------------- (Complete in Duplicate) Date Issued -------------- ---- - ------ ---- ---- - - This Permit Expires 1-Ye� _ � - - - - - - ---- --- - �-�- Year Issued 2-ql- '310—s6 ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbe&: This application is made in compliance with Count Ordinanc No. 549. " PP y Spm. . JOB ADDRESS AD LOC TION' / ---4 ,,Pat--- ---.e�r� ...�--•----------•--------- ----------- Phone.------.........---- Owner's711.__ e(L�,4s ,�_ � Address .............................. Contractor's Name. --.---- ------------------ ... Phone_/?.n?.� � --•- Installation will serve: Residence /Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ __ Number of bedroom �_-- _--- Number of baths _ (-. Lot size ---- s'iQ-_......�K_-2-2-A------------ Water Supply: Public system ❑ Community system ❑ Private �epth To Water Table ........ ft. I r; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Cry Loam lay ❑ Adobe❑ Hardpan ❑i Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes �No ❑ FHA/VA: Yes ❑ No ❑' h TYPE OF INSTALLATION AND SPECIFICATIONS: `\ (No septic tank or cesspool permitted if p ' sexrer is available within 200 feet.) Septic Tank: Distance from nearest well_________----Distance from founclafiqp----AO!________.Material_____rit�—_ No. of compartments__A-----------------Size_545 ,z4.SLiquid depth-.571V'.._____-_Capacity_./._ -PQ Disposal Field: Distance from nearest well. ._._Distance from foundation-60-----------Distance to nearest lot line._f,�+ --. •••- Number of li��'. _._ __ - Length of each liner- -----------Width of trench..�_lz_�__!�_____..._... Type of filter, material s,~ __Depth of filter material �_�'___Total length___.....- ��_ r/ITC Seepage Pit: Distance to nearest well________________ ____Distance from foundation....................Distance to nearest lot line------------ El Number 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----------------------------------------------------------------------- ---------------------------------------------_------ . c 0A - - -----�0/ -------1/V------ - . Remodeling and/or repairing (descr be]._--- --_-.--� ------_-�.-- lY1- . `�.� �-----AA�-�_.--.-•-.._...----•__-. ----------------------------------------------------------------------�"---H1 ------ -4Ta-R-----7-T-70` MI-•�--- :�-------------- ..................................---------- ---- -------•--•-•----•-•----•-----•-•------------------•- ----------------------------------------- 'T_.R�0 -------------------------------------------------------------------- ----------------------------------------•---------------------------------------------------•-----•---------••------------••---------------------------- I hereby certif that I have pre ared this application an +hat the work will b don n accordance with San Joaquin County ordinances, S e a s a gul tions of the Joaquin L is +. (Signed ✓ (4t '�Contrac+or( -- ----- -- ----- -- --.-c�-- ------ ---- -- - --- -- --- ---- -- By:-------------------- - ----------------------------------------------------- -- - ----(Title)-------------------------- - (Plot plan. showing size of lot, location of system in relat' to , buildings, +c., can be placed on reverse side(. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___. Ti_R.c.(-..._ -- --- --- - ___-.__--_-___ DATE_ '�� . ---- - - ----------- ---------------- •-------- - ------ •- ----- -. ---------------- REVIEWEDBY--------------------------------------------- ------------- -- -----------------------------------------------.......... DATE-------------------------..- BUILDINGPERMIT ISSUED------------------------------------------ -----------•---------------------------------•-- DATE------------------------------------------------------------ Alterations and/or recommenda+ions------------------ ---------------------------- -•--••-----------------------------•---------------------------------------------.-------------___------- ---------------------------------------•---------------------- ! cc__---j.------ - ------------ ----------------- -------------'----------------------------------- / - -------- ----------- ---- - -----"a-'� f-------------- FINAL INSPECTION BY:---- 'U-1� � ..... - ��-b �b � -------------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 ZM 9-55 ATLAS