13753 - Laserfiche WebLink

Home Browse Search

--•�-----rVK vl-a ust: _________________________�Ajj �4 APPLICATION FOR SANITATIQN PERMIT Permit No.` -- i -------------------------- •------------ (Complete in Duplicate) Date Issued ------Ma/4/ I --.--- This Ex ires-].Year From Date Issued _ t 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 wi County Ordina ,Alo 4�7 JOB ADDRESS AND LOC TION--f----------A te.----- -• ------- -- --- --- -.. ....---- ---- --- Owner's Name �? Address... ... Phone. -=.r =- = -------------------------------------- ----••----..•.......---•---------------------------------- = ._._:__ Contractor's Name------•- ------------------------------ .:...... Phone._..: • - -•_• Installation will serves Residence ®-"Apartment House ❑ Commercial ❑ Trailer Court 0 Motel 0 Other Number of living units: .1... Number of bedrooms _S-. Number of baths _j;!!:!! Lot size Water Supply: Public system Q Community system ❑ Private Depth to Water Table aim-eft. Character of soil to a depth of.3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe rdpan .Previous Application Made: (If yes,date--------------------) No QR-' New Construction: Yes gR-,No ❑ FHA/VA: Yes P—"No E 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-1,49X_f_..Distancee from_foundation----/�_.__-1 .__.Material-__t __� /^G .......... [Id! No. of compartments---S________________SizeuLP*&;V0x-Liquid depth_--$-'�-------------Capacity,. 4?0 ` . ~� . Disposal Field: Distance from nearest well�_v_r_____.___Distance from foundation to nearest lot�ine_________________ � ,x5,j Number of lines_____-.-._.._ ength of each line_____�s�'__�___.......Width of trench...fes_...•............:....::... 1 Typo of filter material._/t/ f yp epth of filter material..._.:1�_____--.Tota! length---.-..,��'�....:............ :Q Seepage it: '�' .Distance to'nearest well__.- �(J.�Distance from fou dation..._..Ile. :.Distant to nearest to line ......... [ Numbe'r of pits-----�--•------= 9 -��....Depth.-_ �.I......-•--- _Linin materlal._�!__ !fir Size: Diameter.___ ._ -.- Cesspool: i Distance from nearest'-well•______________:_Distance from foundation------------- material-.__.___-----__.---.---._.--_._- ^� ❑ ` Size: Diameter------------------- ------------------ --=-•----------•------------------------ -----------Liquid Capacity----........................gals. .. Privy: Distance from nearest well ____________________`--_i____.__._................Distance from nearest building.-_._:.____..__..-------..-_.-._____-____. ❑ Distance to nearest lot line .'............... ------ -•----------- --_-------------------------------------------- Remodeling and/or repairing (describe): !/(.6 / -- --- - -- y+- ---------------- --•---------•---•- ................... • 1 ` M ...................•-------------- I hereby certify thea'fiiave prtapared�tHis appliiration and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rul s and regulations of the San Joaquin..Local-Health District. --_ (Signed)-------------- ntr -- �` -`= ----------------- '•-•-----------------{fid/cr Co ester). By: ........................................................... - [Title}:... t�/ �=--------- - - -------------- # (Plot plan, showing size of lot, location of system' ation to wells, buildings, etc.. can. .. be placed on reverse side). , t � � 'FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -i-.-i— ........ ------- DATE.------... —3:7:.(� ------------------------ REVIEWED BY---------------------------------------- - -- -----------f ----------- - --- ---•---- ` IQAiE_.. yam'' ::.... BUILDING PERMIT ISSUED ------------------..................._....... D/4TE- .. --- -------------------- Alterations and/or recommendations:-,lr3 ^_l-3--G.f_^_: _ :_____ -:•�.,�-�-��_�� - -- ------------ ---- --- - ::-:. 54-- _ -:�.. .. ---- _�.7�.. --------------------------------------------- FINAL INSPECTION B •... ... !�_ - ---- ----- Date----------, -- -----------------•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 3� r: 130 South American'Street TM�,, 300 West Oak Street 124 Sycamore Street 205 West 9th Street -y Stockton,California t Lodi,California Manteca,California Tracy,California t ES 9 REVISED S-09 YM 6-61 ATLAS ® 5