17957 - Laserfiche WebLink

Home Browse Search

OFFICE USE: F ILI I P - APPLICATION FOR SANITATION PERMIT Permit No. ._%.7 __s.: �� . ��:__ (Complete in Duplicate) 1 ---- ------- -- --- -- Date lssued�- � This Permit Expires 1 Year From Date Issued Application is hereby madeylto the San'Joaquin Local Health District for a permit to construct and install the work herein described. it This application is made in compliance with County� Ordinance No. 549. - -------------- -- JOB ADDRESS A D LOCATION_______ Owner's Name-------- - e"I74 ------tj Phoned 37�"�Address-----P C.' ' t �� ------ ' .. Contractors N ._. hone. lks .d T� I Installation will:serve: ResidenceK Apartment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living uniflps: _'_��__ Number of bedrooms __ __:_ Number of baths __ _____ of size ____... .- r -•-�- -- ---- Water Supply:" Public syst�lrn Community system ❑ ,Private ❑ Depth to Water Table�LJft_ 1' Character of soil to a dep+h ofeet: ; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made (If llf yes,date. 9.Yle-1 No ❑ New Construction: Yes ❑ No l r^�/VA: Yes ❑ No ❑ TYPE OF INSTALLATION&AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) I� tic Distance, from nearest well_f L ._______Distance from foundation--------------------Material---------_-----------_---------------- ________- No. of compartments-- ------- _ Size--------------------------------Liquid depth------------------------- Capacity--------------------- Distance from nearest we . -/-- _Distance from foundation--- 0--�".Distance to nearest lot line:_____i Di sal field: 7p -Length of each line__Lr._1 ---------------Width of trench---o__q!!-------"- Numbe�,of lines----�--- --------------- -------- -- -- 9 - !t - . .�+:;/`--- '� Type of'-filter materia .-__Depth of filter material----.._ ',_____..Total length______________________/_,�__-_________ o g ------ Distance to near t well-> _ Distant. rom f undation-_ ___Q_r_.Dlstance to nearest lot line______�L---_._ Size: Diameter_____4/-.'L/"- p r, ............. Cesspool: N Distance from nearest well_________________Distance from f undation--------------------Lining material____________-.____________________- ❑ IE Size: Dia meter--------------------------------------Depth---------------------------------...----------<-- Liquid Capacity------------------------=---gals. Privy: Distance from nearest well ______________---_-----------------------._----Distance from nearest building______________-_---___________._______._. ❑ II II Disfiance`' to nearest lot line------------------------ ------- ---------------------------------•-'------- ------•-------------------•--------------------------------- l+ Remodeling aid/or repair1�ng (describe} --- = ---------------•--------------•------- =------------------------------------------------- •-•--------------.---- I -----------------------------------=--------•-•-------------------------- - ;IG--------- ------- = ,., E I here y'certify tha+ Illhave prepared this application and that the work will be done in accordance with San Joaquin County ordinance to la , and r les and regulations of the Joaquin Local Health District. =� {Signed}-- i - - f/ }- ( ��bntractor) - ---- ---- - - -- -- ------- - A �I Title By:----- ------- �•— ( ' ] ----------------- - ------------ (Plot plan, showing size of Ilot, location of system in relation to [s, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY r c� 3 APPLICATION ACCEPTED BY------•----------- - ------------ ------ ---------------------------------------- DATE---------- ------------------ REVIEWEDBY------------------- -------------------------------------------------- ------------------------------------------------ --- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE----------------------=-------------------------------------- Alterati ns and/,or recomnien ations---- --- ------------------- --••-----------•-------------••--------------------•-----------• -----------------------•- f/ fi r__- a--- ---ak------------c`� '------- ----------------------- I ---------------------------------------------------------------•------------------- -----•----------------------- ---------------------------- ------- ------------------- --- ' I -- ------------ --- ' �a --------------- --------------------------------------------------- FINAL INSPECTION BY ------------ 9`._�------------ ------------------- date-------- ...... ?'�_. �c` -- ------------------------ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California! Lad!,California Manteca,California Tracy,California II ES 9 REVISED 8-59 3M 3-'63 F;P.- .1 I,