16838 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- r- i � ------------------- ------ ------------- ---------------- ------------------- --------------------------------------------------------------------------- APPLICATION FOR- SANITATION PERMIT Permit No. �l l� •3-•� I (Complete in Duplicate) This Permit Ex ices'1 Year Frorli Date Issued -____ _ .__ .__ 3 Daie'Issued ____________----------- Application __________y A lication is hereby y made to the San Joaquin Local Healfhbistri4 fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No.`549. JOB AQDRESS AND LOCATION - .- � ..3 _N�� --- - = --- Owner's Name !?_ - ••-- Q-lel.:l �'�C '�I 1 f Phone. Add ress----------------------- s � ! r Contractor's Name--- ' 1 _lt Isle - - -• ! ----- ------ ---------- -------- ---- --- r Phone-. - 9 .Q - � Installation will serve: Residence Og? Apartment House ❑ Commercial Trailer CourF ❑ ,❑ Motel ❑ Other'[] , Number of living units: _� � 7- " + __'_ Number of bedrooms _______- Number of baths _-,�___ Lot size __+_s4__x--__-/! _______ Water Supply: Publics system Communit system . } y y ❑ Private ❑ Depth toWater Table _ ft. l Character of soil.to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ Adobe ® Hardpan ❑ Previous Application Made: (If yes,date - -- } --------------) If No New Construction: Yes No FHA/VA: Yes ❑ NoX -,.i TYPE.OF INSTALLATION AND SPECIFICATIONS: # 4. (No septic—tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-AWIC___Distance, . ; fromfoundation__ !0'.____._.Mat 11V -T ___'No. of compartments 04-- Size - -'X.�'_..._Liquid depth-----�z-� - -Capacity._,84_f,2/ - # a Disposal Field: Distance from;nearest well-/.VOWAFtDistance from foundation-__1Q-----------Distance to nearest lot line---J---__:___ Number of lines_______ ar_________________ _Length of each line--------_SCJ _____ __Width of french,-----.__Z_ ---------------- r Type of.filter mateiel___ C* __-_Depth of filter materiallG�s'_��__.To:tal len th-__ --- 9 ----------------- Seepage P -..,.. 7 r 9 - 1 `=------------- Pit: Distance to nearest well________________ __ _Distance from foundation_____'__.-_________.Distance fo nerest lot line__ G ) Number of its Linin material ------------ -- Size: Diameter.- ----------- ---- Depth----------------- --------- -- Cesspool: Distance from nearestwell____`------------ Distance from foundation _ ___________Lining material----------- -- ❑ Size: Diamete ..-- -- -.Depth =---------------------�y----;'°-------Ligu'id Capacity--- ---------.-------------gals. Privy. Distance from nearest waif___-----------------------------------_ -_______:__Distance from.nearest buildin . r e �} . ❑ Distance.to nearest lot line__-A - ---•---------------••------------------------------ -------------------• = Remodeling and/or repairing (des cibe):---_ AA4,1.�/_t4L--------A/L�G[� _ -------------------=-----------•-- _ _ ----------- ------------ -------- _ ____________________________________________ + V= , . ----------------------__--------_-----------------------------________________________________________„_-____________-__ �S I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County'11 ordinances, State laws, and rules and regulations;of the San Joaquin Local Health District. �' 1 -' t f (Signed)-------------- - - ------------------- -=-------------------- O or Con ner and/ tractor) BY= 0 _._ {Title) �� -------- ------- --- -- . (Plot plan, showing size of lot, location of system in rela#ion to wells, 6uildings;'etc., can ke placed on reverse side). Y t - * FOR DEPARTMENT USE ONLY P ACCEPTED BY ---------- --9— APPLICA�TIONL�f' ---------------------------------------,DATE---.----I-- . 7- �. € REVIEWED BY t ` ------- ------ --------------------------- bATE-------- I,- PERMIT ISSUED - ------------------------------------------------------ ----------- DATE------------------------------ - ----------------------------------------- q. .. - - ----------------------- A aerations and/or recommendations:_-_.___.___- ` " "'"'" ` -- l - ------------------------•-•-----------------------------------•------------------------.__.-----------------------3---------- ----------------•------------------------------------------------•---------------------------------------------------------- .--------•----------------------------------------------•---------------------- ---------------------------- •----------------------------------------- --------- ----------- -------~ ------------------------- lEI ------------------- ------- ----------- # : = ' FINAL INSPECTION BY:---------------------- . -----¢� _ �- ------------- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Streeti 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy California ES 9 REVISED B-59 3M 3-'63 F.P.C[3.