17104 - Laserfiche WebLink

Home Browse Search

J FOR•OFf10E 115E: rte' i J Permlt No. _-..l ! bf -0' APPLICATION �G?R-SANITATION PERMIT __ _�_ ,_,__ _ (complete in Duplicate). Date Issued --------- ------------- ------ ___.� -� __ _ f-_ _ LL This Permit Ex ires 1 Year From Date Issued . Application is hereby made to the San Joaquin Local Health District for a permit tq cortruct n Install the work herein describe . 1' liance with County Ordinanc No. 49. 3 '3a 6�- This app Ication�is made in comp I �`TLON _ - ------•-- - ------- ----- --------- - -- --- f.✓4� ----- -------- Phone '_14T 7� � JOB ADDRESS AND LCC E Owner's Name_ _� r -------------------------------------- ---•------------=---------------------------------------- Address---r 2 ne --- ••--------. Ph Contractor's Nam --- ------ ------- --•---- ------------------- z, *. Installation will serve: Residence �}Cpartment House ❑ Corrimercial ❑ Trailer Court Motel ❑ Other El Lot size . -- - r ------------------ --Number of baths I__ ---- Number of living units:.:(_-___ Number of bedrooms _-_ _-_ ! Private ❑ Depth to Water Table _ t: _ Water Supply: Public system �,ommunity system ❑ Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand [IGravel ❑ Sandy Loam F1 Clay Loam El Clay ❑FNA VA: Yes [INo �— Previous Application Made: (If yes,date-__- ----) No New Construction: Yes 0—fl-0 [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) It ------- I Septic Tan ' Distance from nearest well -----Distance from foundation__.r -------- Material__._"___-__. --"_______ ______ , :. Size X" `' Liquid depth-----------------------Capacity.... -- No. of compartments- ___'��- D �-._.._.Distance to nearest lot line___.-___."__ posaI Fi Id: Distance from nearest well__- ._.Distance from foundation_-__..__ Width of trench___.�_�__�----`_.------- Number of Imes_____________ Length of eachline__��' --- -----= Total len th `� ------------ m 1 { Type of filter material_____ __ rG- -:Depth of filter aterial_ _ '______--- 9 Seepage Pit: Distance to nearest well___'-"___-"__--____Distance m founda#ion;_�A___�_..__..Distance to nearest lot line-------- _ G/(Size: `Diameter._--� __.Depth_---��j------------------ �% Number of pits-.--____l-_"__"._:__.Lining material---- "_sa-- F --------------------------- Cesspool: __ _________________Cesspool: Distance from -nearest well_________________Distance from foundation- "- Lining d Cat act gals. ❑ Size: Diameter =-Depth----------------------------------------------- q Capacity s Distance from nearest building-------•--------------------------------- Privy: Distance from nearest well--------------------------- -- _-- 0 Distance to nearest lot line-------------------------- ------=........ ---------------•----•------------------------------ - Remodeling and/or repairm „(describe}= ---- �~---t---- --- �------------.-- -- --- ---------� c::-x..crT�----7- t �� ----- ------------------------------------------------- - k ` ared this a plication -- the# the work ----•--------- - -----------•------------------------ t San Joaquin-County o to Coun y . --------------------------i-y-_t --h have ------- will be done in accordance wi h equ• _ t ai I hereby certify that have prep (' ordinances, State laws, and rules and regulati ' of the an Joaquin Local Health District. _.(Ocaner and/or Contractor)- ----- ------------ St ned (Title) ---------------- --------- -•--- (Plot plan, showing size a ion a Sys m in relation o wells,.buildings, etc., can be placed on reverse side). 1, FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.--___ /L_'------ -- "------- DATE------ ` ----------- • t ------- DATE.---------------------------- ----------- ----------------- 1 REVIEWED BY ----------- ----------- ------------- - ---------------- �4� DATE BUILDING and/,oIT ISSUED --------- -------- ------- � f - � _ ��,�A-��_F�-=.-•J---�=�'-`-�C------- er. ---= `.------------------------------------------------------------- ------------------------------ r recginmendations:-___ -.-. .v - -- ---- - - ----- - ---------------------------- -------------------------------------- -------------------------------- --------- -------------------- .. ' ---------------------------------------------- Date_- ------- FiNAL INSPECTION BY:-------- -rN --------------- S - - r ,. r AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 30k Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California , ES 4 REVISED 5.54 3M 3-•63 F.P.0O3 t