16914 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------- ----------- ..... ------ t No. � � �� --------------------- APPLICATION FOR SANITATION PERMIT Permit .(Complete in Duplicate) Date Issued .?7b_�h ----------------------------------------------------- i --- -------------------------------------- ---------- - -This Permit Expires I Year From .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 with County Ordinance No. 549. 1 E: 1-0 7SCR rp_�bl Y 14E�erZJ _A. j_ ----------- --------- 4 _&_�......14 ------- -------- JOB ADDRESS AND LqgATI N...---------------- Owner's Name--------------1&Y-------- ----------_---------I------------ - --------- --------- -------- ----- Pho.r.e.-- ----------------------- ------------------- ----------------------------•-------------------- Address--------- --------- C-P, S>JA_Lg�------------- Phone----------------------------------- Contractor's Namei0l . K !Trailer Co-ur t 116use E] 06nnmercial-B-V V I [] Motel El Other El 'Installation will serve: Residence,Apartment I Number of living units: --_r__- 'Number of bedrooms Number of bathes Lot size --- V I Table -&0-� ft. Water Supply: Public.system 0 Community system [I Private ir],,�,Depflijf9 WaterTV Character of soil to a depth of 3 feelf: . Sand ❑ Gravel 0 Sandy Loam'la--Clay Loam El Clay El Adobe Hp --No El FHA/VA: Yes F!r, No [I Previous Application Made: (if yes,elate.-_----------------1 No J�' New Construction: Yes je d, TYPE OF INSTALLATION AND SPECIFICATIONS: (No�L_�-- '� public sewer-is available within 200 feet.) -septic tank or cesspool permitted if Septic Tank:.,"`-!`'—DistancA frdm ni�arest well---��L'Distance from foundation---/ ---------Material clep�h----LZ P./ -----Capacit'..."Ix <_9 7 ' -7-----__-----Size__ d No. of compartments_-------x Distance from nearest well J Distance from foundation---------- ---------Distance to nearest I&t line_________.__.____ 3P X i ------------------------- okeach line--,-- Width of trench --------------- _4------------- C Number of lines-----------------t_vti 1�1 ��17; Type of-filter filter material_____________________ Total length--------------------i------------------ Seepage Pit: Distance to nearest WO-----------/ Distance --------Distance to nearest lot lineZ�------------- 'i---- .3 4,' "�"I"FJ"-' '='7''�' Number of pits.!---- ----------Lining r6fei�ik_ _-____S;ze7�Dibm&f&r---------- ------------Depth------------e----------------- 11 - %-7_4-:; _�_4-:; .ter ;_1 , Cesspool: Distance from nearesttweQ�--------------!Distance from foundation_------------------ Lining material---_-------------I-.:A:__'' - - --------- Liquid Capacity Size: Diameter------- -in-------------�:Depth---------- ------------------------------------------ ----------------------gals. V, - -- --------------- Privy: Distance from-nearest 4elln�------------- --------------._Disfance from nearest buil --------------- . 7t -------------- ............... -h ------------I---------- --------- ................... ❑ Distance to rieai`rest�j lot.line-'----------------- - ----- -- --------- > -----------------a Remodeling and/or repairing (describe)----------------_-----------.------ - - -------------------------------Q1-------------=-----------i 'A'. --------------------------- ------------------------------ ------t---------------------------- -------------------I--- : % N ----------------------------f -------------------------------- -------------------I----------------------------------------- ---------------------------------------------_---------------------------------------------------------------------- ----------------- i ---------4---------------------------------------------------------•--------------------------------------------------------------------- --------------------- ----------------------: . . .. .. . _k -� 1,.-*_accordance 0 1 hereby certify that I have prepared this application and that the wor will be d6ne in with San J:aquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1---- ------------------------------(Owner and/.or Contractor) By:. ------------------r---------------------------------(Tif le)----- ....... ------------ ---------------- - ,* etc., can be placed o6 reverse sidel., n owing size o locate rn n-relation.fo wells,-buildings, ce (Plot'pla f lot, fO'c 0 system FOR DEPARTMENT USE ONLY fAPPLICATION ACCEPTED ...... ------------- -------------------- ---------------------- DAT -- Z ----- -------------- REVIEWED BY----------------------------------- --------------- -------- ----------------------- ------------------------------ - DATE------ ----- - --------I--------- -- BUILDINGPERM I--ISSUED---.r.';.. n - ------------ ----- - ------ -------------- - - - IAlferaiioni and/or recommendations:. ._-_---------------------------------------------------------------- --------------------- -------------------m----------------- -------------------------- -t �---------------------------------------------- --- r -------- ---------- r --------------------_----------------- ------------- ---------- -------------I-------- ---- -----------------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- --------------------------------- --------1 ---------------------------------- --- ----------------------------I-------------------I------------------------- ------------------------------------ ----------------------------- - ----- - ------ - --------- --------- ---------------------------------------------------------------------------------------------- ------------------------ FINAL INSPECTIO BY-Z---------------R_ Data_------ -------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 9 REVISED 13-59 34A 3-'63 F.F.013.