17033 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ., s. ` j Y I __ Permit No. _471_0 - ----- ---- --------- - APPtICAT10'�I FOR SANITATION PERMIT --- ----------- (Complete in Duplicate)licate p ) m � Date Issued 3!-=�:•---�°--� 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 instalt the work herein described _4,This application is made,in compliance with County Ordinance No. 549. .-- ! JOB ADDRESS AND LO A — __._ Phone-------------------- - Owner's Name--------- - ' ---- ---' ?f -� ' '"-------- - /j�/;' R ---------•-------•-- ----------------------------------------------------------- -•---•-----•-------•__________________________________ _______________ Address--------------- t F -----�!f -.. �� Phone Contractor's Name---- ----------------------------------- __ Motel ❑ Other [3 I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court �° Lot size --e Number of living units.,__/_. Number of bedrooms ,..1___ Number of baths - - j'ft Water Supply: Public#system ❑ Community system ❑ Priva#eDePth to Water Table Sandy Loam ❑ Clay Loam ❑ Adobe E] Hardpan El Character of soil to a depth of 3 feet: Sand E] Gravel ❑,,,/ FHA/VA: Yes R"No ❑ Previous Application Made: (If yes,date----------- Noi New Construction: Yes [k}�`10 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)`', _ / Septic T k: Distance from nearest well___-�-�--Distances'{r�om fo`ndatio�n___ ___ __- It No. of compartments_._.- Size, '-V •-�~ �� Iquld depth P Y __.Distance to nearest lo line-_ E ' Disposal Field'. Distance from nearest well.... t -"Distance from foundat�i`�ojn___---�_--.---- s ' Number of lines----- ---- r e 9 off flte h miaterial-_ �f----Total hlength of trench.. ;--- ------------------------ do T e.of filter materiai_0A - _ P fb YP �° ' D Distance fr m fo rldation__X—9. - Distance #o nearest lot line_--------•- J Seepage Pit: Distance to nearest well ��/' Size: Diameter__: .r ----[}epth_ � Number of pits-_-------------Lining material Cesspool: Distance from nearest well ___-------------Depthce from foundation---------------------- - --- --Liquid Capacity-----------------------------gals' # ❑ Size: Diameter------------- _ i------- ----"---------------- --=---- --------------- --------- E Privy: Distance from nearest-well___---"_____--______--_-_.__-___--------------Dtistance.from nearest building g ❑ Distance to nearest lot line----------------------------- -------------------------------- Remodeling and/or repairing (describe :----------- l-_ -- ------------------------------------------------------------------------- -------------------------- ------------ __________________ T _�i___________.__ 6. _-________________________.-______-____--"______-____-___-.o________ ________________ _ ____ _ ___ _".___ __________-______.______________________-__ ___.__ . ___________-_________________-_______-_______-__________-_______-__.____.___________________-_____ I hereby certify that I have prepared this application andioaauinhLo alkHealtheDistrtctn accordance with San Joaquin County , ordinances, State laws, and rules and regulations of the San q = -------------------------------------------- Contract orl (Signed) ` -- ----- ------(Title ned _ )- -- � - Plot plan, showing size of.lot, location o: By:__.. ------------ ---- g P - ( f syst in relation to.wells, buildings, etc., can be laced on reverse side). 5 FOR DEPARTMENT USE ONLY `�� -_------------------------------- ------------------ DATE � APPLICATION ACCEPTED BY--- . _�'�-�-;..•. - _ -•--- DATE REVIEWED BY----"----------- -------------- ------------- ----- -- ------- ------.-1- DATE------------------------------------- ---------- K BUILDING PERMIT ISSUED_ --•------------------------------------------- Alterations and/or recommendations-------------------------------- ----------------------------------------------------- - ---------------------------- --------------------------•------•------••-------------- ---:------------- ------------------------------------------- ------------ ------------ --.- •--------------- ".- �- - - C � ---- Date--- -------=---------------- - ---- -� - --------------------------------- FINAL ----- - I FINAL INSPECTION BY:.----.--��-------- - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Haselion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Lodi,California Manteca,California Tracy,California Stockton,California 4 ES 9 REVISED 13.59 3M 3-'63 F.P.CC.