17739 - Laserfiche WebLink

Home Browse Search

:OR OFFICE USE: ------------------------ ---- _ APPLICATION FOR SANITATION PERMIT Permit No. -___.-_ ------------------------------------- - --------------- (Complete in Duplicate) Date Issued -- '/ --,� _.._----------------------------- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San'Joagbin Local Health District for a permit to construct and install the work herein described. This application is made in com Bance with County Ordinance No. 549. ' VV1F' = JOB ADDRESS AND LOCATI N--------- --- ; k'i73------ V ---- �Owner's Name-------------- _ a --- --------- PhoQne.. -G---- --D-----I-t-S-�-L`-LI•-------�---- — DAddress .... Lf- Contractor's Name----------- 0 � ------------ .-------•------ Jnstallation will serve: Residencepartment House ❑ 'Commercial�❑ Trailer Court ❑ Motel ❑ Other ❑ + ----- ----------------- Number of living units: ---t--- Number of bedrooms __�_____ Number of,;baths ___I_-_ Lot size 2 Water Supply: Public system ❑ Community system ❑ Private &pth to Water Table it.lop i Character of sail to a depthRof 3.feet: Sand ❑ Gravel El Sandy Loam ElClay Loam Clay ElAdobe ElHardpan Previous Application Made: (If yes date________ ___________] No New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No rf TYPE OF INSTALLATION AND SPECIFICATIONS: � _:�_ (No-septic tank or cesspool-pe7mitted-if-public sewer-is available-within 200-feet.) -==•_�^ � - SepticiTank: Distance from neare t well, ------Distance from foundation----/0---------Mate ial___ f1[[:J i _r_ _ -___. No. of compartments- J p ---- - --Size-��---=- �--X-�--Llgwd depth---- ------------Capacity------tj �--- ------- ' 1 ++ Disposa. Field: Distance from nearest well.:,.r_-____...._Distance'from foundation____________________Distance to nearest lot line------------- Number of lines----------------------- --I t_Length of each line-----------------------------.Width of trench--------------.-----------------.-- Type of filter material----------------- t�"Depth of filter maferiaf----.------------------ otal length's;-------------------------------------- Seepage -----------:_-------- _----------Seepage Pit: Distance to nearest well- --------Dicstance'from foundation,-,................Distance to nearest 18t--line----------------- ❑ Number of pits----------------------Lining material----------.--------'.Size:iDi6meter------------_-_-----Depth-----f!-=---s;s_____::_.__------ Cesspool: Distance from nearest well---------------__Distance;from`foundation..." ---:""'_._Lining material------ --------._______ I Size: Diameter------------------- -_.De th----------------------------- ---gals. P, t ❑ --------------- p ----------------------Liquid Crapaa#Y----------------------- 9 t Priv Distance from nearest well.................... ______________._..----------Distance-from neaies# building ❑ Distance to nearest lot line__________________ "'' ; ------ -----------; ---'----_�_�__...-_--r-----------------------------------------I--------------- --- -C)IA.1.4.4 1 VJ'J ---C)IA.#.4r1VJ'J Remodeling and/or repairing (describe):-------------- ----- --------= - - ---------•--•--------------- -•-•--•-------------------------------------•----------------•-•--------------- --------------------------------------------------------------•----------------------------------------- •---•-------------------•----------------------------(------------------------------------------------------ -------------------------------------------------------------------------------------- ---)--.--------------------------------------------------------------------------------- - ------------------------- hereby certify that I have prepared this application and•they the work will'be done in aaccordance with San Joaquin County. ordinances, S+at5`laMls, and rulesandregula`�tons of the San Joaquin Local Health District. l.ZCr ICY A (Signed(---I�l�f__ - ----------------------------------------------------'------------------ ----------------------------------- --------------------{Owner and/or Contractor] (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY ! - APPLICATION ACCEPTED BY---- R-4 -------------------------------------------------- DATE----- = --------------- REVIEWEDBY----------------------------------- -------------- ------- ------ --- DATE----------------- J BUILDING PERMIT.ISSUED------------------------------------------------_------------------------=-------=-------=------------.DATE----------------------------- ----------- ------ Alterations'and/or recommendations------- -------------- - ---------------------------------------------------------------------------- ------------------•------------- c. .r.., ---------------------------------------------------------- -------------- -------------------- ----------------------------------- --•----------------- -----•---------------------------------------------- - -- - - -------------------------- - ---- 4.1 -- - ---------- -- - ---- ' �t wr SVT #.1's1�f4 °1 FINAL INSPECTI - ! ----- -- Date----------------. - � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffoxelton Ave. , 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California E5 9 REVISED S-59 3M 3-'63-F.P.CD.