17602 - Laserfiche WebLink

Home Browse Search

../`FOR OFFICE USE: -------------------=------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No.l_-7 ._ .Z— __---------------------- -------- ------------------ --.. .- . . (Complete in Duplicate) (vI --Date Issued ----------------- --------------------------------------- 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 install the work herein described. This application is made.in compliance with County Ordinance No. 549. : (fps-- /3a-1s' �'�$'�.�Z �i.1..�u i✓!Cwt �f � 4 JOB ADDRESS A LOCATIONf, c- Owner's Nam --- --- . . Pone - - --------------------- Address------- if-- --- - ........ A e-•-- -- --- -------------------------------------- ------ Contractor's Name____ ----- J----------------- Phone---------------------_---------- Installation will serve: Residence [,Apart ent House ❑ Commercial Trailer Court [-] Motel ❑ Other El .Number of living units: __/___ Number of bedrooms Number aths J--- Lot size __zo—i, 7_,rrf�.__l$/______________________ Water Supply: Public system E] Community system ❑ Private Depth to Water Table<lay ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel C] Sandy Loam ❑ Clay Loam ❑ Adobe ❑ Hardpan ❑ Previous Application Made: llf yes,date.................. .} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: + � (No septic lank or cesspool permitted if public sewer is available within-200 feet.)_- -- f, �. p� � � , �.--�� - -foundation__,l(�-�•-`----.Mate�iaL� _ . ._ ; No. of com artments.-_ Size ` Se fiic nk: Distance from nearest well.-m D__ __Distance from � Llquid'depth_-_ PC Dispos Field: Distance from nearest well ________ _____Dista,nce from foundation__�� ------Distance to nearest lot Ilne ___ Number of lines------- ___ _ _ ________Length of each line------/00-_________._._.Width of trench----- ___-____.--------.._ .s Type of filter material__ Depth.of filter material____-/�---------Total length---... -------------- ^� Seepa Pit: Distance to nearest well_ _.___Distance froin foundation-------- Q_--_.Distanc--e to nearest lot lin,__,... __. Size; Diameter---- Number of pits-_ — Lining material__ �_._ ___... De th,- ._ CessPool: Distance from nearest well______--____---_Disttance' from foundation----------------- 'Lining materi --- -- --------- } El Size: Diameter-------------------------- - -------De th---------------- ---- ------ - ----Liquid Capacity - - - ---- 2�als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----_--------_-_-._______-_.___--._. l ❑ Qistance to nearest lot line =---------- Remodeling and/or repairing (describe) --------------------•---------------------------------------------------------------------------------------------------• 1n t --------- -----------------------_-------------•----------------------------=--•--------------------------------------------•--------•-------------•--------------------------------•------------------------- ------ I hereby cerci t I have prepared this application and that the work will be done in accordance with San JoaquinCounty ordinances, Stat aws , nd rules and regulations of the San Joaquin Local Health District. F l� 72 (Signed)-------- - ------- t3nd/or Contractor) A� By:------- --- -------------- - ------ ---------------------(Title)----------------------------------- (Piot plan, showing size of lot, location of syste in relation wells, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY- - - ,r�_,z,_4e,_e ------------------------------------------------- DATE------ -------------------------- REVIEWED --------REVIEWED BY------------- ----------------------------------------•---------------------------------------- DATE------------------------------------------------'------- -- BUILDING PERMIT ISSUED ------------------------------------------------------------ DATE - ' Alterations and/or recommendations___________________________ - t' ---------------------------------------------------------------------------------- 1 -------------------------------------------------------•------------------- ---------------- ---------- ----•----- -------------------------------------------------------------------------- ---------- -•-------------- FINAL INSPECTION BY:.,e55; �, ! ---------- Date---- --} - . --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.F.CD.