17898 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------------------------------------------- - APPLICATION 1=0R SANITATION PERMIT Permit No. _1 _._. ----- te)- IThis_Per--mit Expires 1 Year F Date Issued Date Issued --- Ica,... From Application is hereby rinade to the San Joaquin Local Health District fora permit to construct and install the work herein d crbed. This application is made in compliance with County Ordinance No. 549. ,J = t flS— 04 2-r 7 JOB ADbRESS AND LOCATION_ _�_ _ '___ __ ___ c �.t�u _G -_ �- � � _ ----------` � ; OwnersName----- ..JJ - - ---------------------------------------- -------------------------- Phone-----•------------------------------ Address------------ -------- --a�..- '1- ----f.__...... ----------- -----------------•-------------- i Contractor's Name----------- ��' A ---------- Phone Installation will serve: Residence A artment House [,� p ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. ; Number of living units:.__ Number of bedrooms#;Kumber o aths Lot sizer.._-._��"r-4 Water. Supply: Public system ❑ Community system ❑ Private Depth to Water Table':t_._._ ft. i Character r of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam ❑ Clay Loam ElClay Adobe E] Hardpan E] Previous Application Made: Ilf yes,date..__.___-_-..-----) No ❑ New Construction: Yes E] No ❑ PHA/VA: Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) t + Septic Tank: Distance from nearest well___.............Distance from foundation--------------------Material-------------------------------------- -----:--. � ❑ No. of:compartments--------------------------size--------------------------------Liquid depth--------------------------Capacity-------------------- N Disposa field: Distance 4from nearest well___@.....-Distance from foundation------'!_d_,._-...Distance to nearest lot line---S----__---- Number of lines-__ 12-- -_ Length of each line---16��_��4__.Width of french-------Z------------------------ T ------------------- Type .of filf6r-fnaferial-�, _,--------Depth of filter material.-__-/0---`_�---- Total- length------ ------------------- Seep Pit: Dis ince to nearest well-------1-0['3-_f_Disfance from foundation-....../V---..Distance to nearest lot line__�_�__ i P �--------- g - �..P_._.Depth--- ' � Number.of its__. Linin matenal_____.__"_�-_:__=_-Size: Diameter.____ _.._ Cesspool: Distance from nearest well______.-_.__._-Distance from foundation______________.__-.Lining material._._.__.....___._..___._..___.._,_. �a ❑ Size! Diameter------ -----------------------------Depth-----------------------------------------------------Liquid Capacity- - ------------------------gals. I ` Privy: .Distan�ejrom nearest well-------------------------------------------------Distance from nearest building -----------------------.-------------.-. ❑ Distan6 to nearest lot line------------------------------------------------------------------------------------------------------------- ------------------------------- Remodeling anti/or fre airing (describe):--_ _.._-_ _ ¢ ----------------•-•-•----------- = - - - ------------------ ------=-----------------------•------- -----------------------------------------------------------------------------.---"----------------------------- ------------------------•--1---- --- -----------------•-------------------------- ---------------------------------------------------------------------------------------------•----•-------------------------------- - :I hereby certify that I have prepared-this application and that the work will be done in accordance with San Joaquin County o_rdina`nces, State laws, nd rules and regulations of the San Joaquin Local Health District. -"—_— Si ned ---- ----- -------- ---------=--� -- --- -------- --e4l ---- ------------- ------------------------------------- - - /or'Contractor - C. r ..: ------ T- ---- ------------------ - --��- __.'It a-- ----- ------------------ -------..._..--- --- (Plot plan, showing size of,lot,..loca+ion of system in relatiowell s, etc., can be placed on reverse.side). _ f_ t ' 'FOR-DEPARTMENT USE ONLY APPLICATION"ACCEPTED:BY - -------------------------------------------------------- DATE--- " ---------- ----------------- REVIEGADBY- -------------- --------k------------=------------------------ ----- ----- - --- DATE------------------------------- BUILDINGPERMIT ISSUED---------- -----------------_------------------------------ ------ DATE........... --•------------------------------------------ Alterationsand/or recommendations:---`-------------------------------------------------------•-------..-..--•-----------------" -------•----------•--•--------------------- ..-._..----- t :ti �- : -------------------- - •---------------- -- -------- '"------------- = -� ---- ------ ------- --------------------------------- ------- ------------------------------------ --------------------------------- ------ ------------------------- r FINAL INSPECTION BY ------------------- �,�. ------------ ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 31A 3•'63 F.P.CO.. 0.