13955 - Laserfiche WebLink

Home Browse Search

FPR OFFICE USE: r--wry-- - - 4 -4 � �,j Ln � � J • � l APPLICATION FOR SANITATION PERMIT Permit No. __::.4 �. � -------------- Date Issued .._w------ (Complete in Duplicate) / A,/, ---------------------------------- This Permit Expires 1 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. JOB ADDRESS AND L CATION -7------ -mit • --------- ------------•---------------------------- Owner's Name......... i e,e, ------- F ------ Phone.............---------------------- 1 -------•-----------------•----------- Address----------------................... .7Q '------ -----------------------------_........................................... •-•••-•-•---........ E Contractor's Name................ L6_1L1 `/ ------------------------------------X-- ....... ---•.___. Phone................................... Installation will serve: Residence ❑ Apartment House [�/C ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ U Number of living units: .. ber of bedrooms _Number of baths _..r1__ Lot size; q_�-x.1�o---=-------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table'�7ft. /. Character of soil to a depth of 3 feet: Sarld ❑ Gravel ❑ Sand _L ❑ Clay Loam ❑Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No Construction: Yes ❑ `No 0--FVA_/VA: Yes ❑ No�� TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic to-n-Vor cesspool permitted if public sewer is available withiri-200 feet.) ; Septic Tank: Distance from,-nearest well-----!=t=Distance--from•foundation.........: Material................................................. No. of compartments--- '-- -----------Size---------------------------•---U uid depth----------- ---------Capacity....................... Disposal Fie[ Distance from nearest well-----'-----------Distrsnce from foundation.....................Distance to nearest lot line................. _ Number of lines------------- ------------Length of each line------------------------------Width of french----------------------_-........... Type of filter material..'-.. ..`___-_______Depth of filter material-----------------------Total length...-----________.-..---_.._--_-_-_________ \ S epage ,it: Distance to nearest w II.t ___'___________Distance from foundation__/-�__i-___-...Distance to nearest lot line_4_-./-___-_ Number of pits....... ----!_Lining mate ria l_rQ - ---Size: Diameter____� ...:.Dept _.__________. Cesspoo: Disfance from nearest well_---_-----------Distance from foundation.__._.--------------Lining material..______-__-_______--..__.._....._._ \1 i Size: Diameter----------------------- -----------Depth---------------------------------------- - - ----Liquid Capacity --------•-- gals. Privy: a Distance from nearest well_I-_!____________________________________-_____Distance from nearest building----------------------..._-__-_.---_____. ❑ ! " �`� Distance to nearest lot line--------------------- ------- -----------------------------------.......... •---------••-----=----------------------------------------._.. I Remodeling and/or repairing (describe):--------' ---- -----------------------------------------............-•-------- .-0\ ------------------------_........._------------------------------------------ -----------------------------_-----------------------------__------_------------------_--------------------------------------------------------_........_______________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws;and rules and "ulations of the San Joaquin Local Health District. -�® --- �----------------' --....----•------------------------------------•-•------ ------._-(Owner nd/or Contractor) (Signed). By= �� T1> - - Erfle)..:�tt1 -- -- ........... -- -------------- (Plot,plan,.showing.si e.of lot, location of system in relatiar�t0 wells,--buildings,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY/ APPLICATION ACCEPTED BY-- R C -------------------------------------------- DATE.----- ---`------------------------------------------- --- 2'--- --�--2------------ REVIEWED BY _. ------ T-_ �.� ,. :•.: PATE ------------------------------------- .---- -_ BUILDINGPERMIT_ISSU'ED--•---------------------•------------------------------------•-------------•---•---------•-------- DATE---------------------------------•--------=------------------ Alterations and/or recom a d'ations--------•--•--- J --------- ........- --- ------------- ---------- - ------- /k� 11, / +'] ________________________________________________________________________.___.----_--_-'--._.____-------_---.' _____. . -----------------__----------------------------------------------------------------_________________..---'_____1_.__...._..___--_______________.__--_----......-----------------------------------:---------------------- 1 � FINAL INSPECTIONBY:____- �.-- - -__--•--- C ----------- Date----- - ... ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American STnat !.._x-300 Wast Oak STraat s 144 Sycamore Street 445 Wast 91h Street 4 0 Stockton,California Jodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 RM 6-At ATLAS