17269 - Laserfiche WebLink

Home Browse Search

FOR OFFICE_USE: - ---- -------------=---- ------ - - --- ------- APPLICATION FOR S~ ---------------------------- ---------------- ANITATION PERMIT Permit No. -------------------------- --- -------------------------- (Complete in Duplicate) 7 1 ___________________________.___._--._,_.-__.____._ pate Issued -- This Permit Expires 1 Year From Date Issued V -_-- ---_- � Application is hereby made to�fhe San Joaquin Local Health District for a permit to construct and install the work here-in described. _ This application is made in compliance with County Ordinance No. 549_ �� � .c e OB ADDRESS A_ND MRNTfl--` Owner's -------- �... Address �� I C7> / 1j - '---------- -----------------------------•--•--- •--•----------------------------- --------------------------------- Contractor's Name-------d 1�f .`------------•---------------------------------I--------------------------------------------------- ------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other Number of living units: _T___ :Number of bedrooms __� Number of baths __L__ Lot size ----- A-C-}R l,_:_4.ft�__________________________ Water Supply: Public}system ❑ Community system ❑ PrivateV Depth to Water Table____ Character of soil to a depth of 3 feet: Sand ./Gravel ❑ Sandy Loam [I Clay,L-oam ❑� tlay E] Adobe E] Hardpan [jPrevious Application Made: (If yes date.- ) No'❑ New Construction: Yes L�'No ❑ FHA/VA: Yes �No E]_-TYPE OF INSTALLATION AND.SPECIFICATIONS:.___ . ...--,.�� - •� ; w.-w.,-,.-,�.�--- _•�-.�-•-. y { No se tic tank or cesspool permittedrif ublic-sewer isyavailable within 200 feet.) �-- p No. of compartments_. -.- :___.Size_- -X �_.x_�_ �Li uid de th---- ----- -------------Capacity Septic k: Distance from nearest well-_25- ____Dista e from foundation--.--/____---------Material____RF-D _o©-�Q© 4 Disposal Field: Distance ber of lines nearest� II_ -�� -_Djstance from foundation�_J(2______-__-Distance to nearest lot line-� �,.o �_ _ - ------4 ength oil each line-----_--9C��"'!�h_�Width of trench------2_�-�------------------ Type ------------- Type of.filter mat iaL_ _ _ Depthc,of;{filter material___-__eRDiameter I�gth___-____-__ 4 __ ____________ See�ge Pit: Dista rest we ----- ---- e from foundDistance toe -ht lot line_-�__.:_:----- Numbeof pi=tS�--------------- -- _Lining material - Size. -- -_ Dpt -------------- ----- ' . ( Cesspool: Distance rom nearest well___ Distance from foundation------------_------_Lining material___-__-_ _=_f_______-_ ( ' Size: i ter----- ------------------------------De th -------------- ------------------------;-----Li uid Ca acit-- ----- ------- ---- gals. jkl 4:5 Priv Dista from nearest well----------------- ---_____---__-____ Distance from nearest building y g_---_ D ❑ Distance to neares lot line------------------------- -- J-------------- --- ------------------ --- - Remodeling and/or repa+ri I (describ[_ _t_T ______ W RS__ '_•/i}F? W�_T ---------------------------------fO---------------- ------ -__ WE-I--t 1�(��-------- C- v-Rct#.----_5r+..nl, r ----tfQ -—_ __��--t�_A1T� _ wRS R cc'JM��-ET - *------ ----------------------- -------------------------- L.. ---------`----------------------- ' =--- -----------------------------------------------•-----------------------•-----------`--------•------------------------------------------------------------------------- i i fi �� O 1 hereby cer'fy thatrl have repared this application and that the work will be done in accordance with San Joaquin County C ordinances, St e w ,Wand .r° � nd regulations of the San Joaquin Local Health District. V►' i � - P (Signed) ___k__ / -- _ -_- - __ _____________________ _ Owner and/or Contractor BY--------------------------- ......... _- ------------------------------------------------------.----------- --(Title}' - ---' -----------; -- (Plot plan, showing size of to+, location of.system in relation to wells, buildings, etc., Gari be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- { R L�' ------------------------------------------------------ DATE------ '- -------------------------- REVIEWED -- --------------------- REVIEWEDBY---- -_----------------- -------------------------------------------------------------------------------------------------- DATE------- -------- BUILDING�PI=RMIT ISSUEbv __ _ .-_r--. -. :: ,- �_.__ t =DATE:-__ -•--- --- Alterations_and]or:eecomiriendations:'� = - _ ------------••------------------------•------------ ----- �.. . t------ �-" -- -- ---------- ------------------ - ---------------=-----------•----------------------------------------------------------------------- ------------------------------------------------------ FINAL IN5PECTIX. - - - Date------------ ._ -.f7.. ---------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 ArVISE❑ a•59 3M 3-'63 F.P.CO- _~"'°- `�►