17172 - Laserfiche WebLink

Home Browse Search

FORR OFFICE USE: f .. I--!^'I -w____.-- ---.,Y•"' -- n"�4++" .w C'« �4 w r j :4 -- --- 411 APPLICATION FOR {SANITATION PERMIT Permit No. . -�I157_�_,_�----------------=--- r (Complete in Duplicate) Datefissued ' ---- ? __ ________..___._.__.___... This Permit Expires 1 Year From Date Issued Application is hereby made to the San .Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Or anc No. 549. Z�A JOB ADDRESS A D LOCATION___--_�`�'- --_-._- _ _ Name.. - ------- • - ----- - - - ----- - ------------ Phone / F --------------------- Owner's Address :--r•.... _ ------•---------•-•-------------/-••-------------------- Contractor`s Name -------------------•------------------• ----------- Phone_ le..-l ! Installation will serve: Residence Apartment House ❑ Commercial ❑= Trailer Court ❑ Motel'❑ Other ❑ Number of living units-/ Number of bedrooms _C�--_ Number of baths _/-- Lot size _-__--:5'd --------------------- Water Supply: Public systemCommunity system ❑ Private ❑--Depth to Water TableA/4'49_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0�,Clay Loam ❑. Clay ❑ Adobe) Hardpan ❑ : I ' jr——1 1 Previous Application Made: (If yes,date._°-----------------) :No El New Construction: 9 /VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f nk: Distance from nearest well---------------F Distance from foundation--------------------Material------- --- No, of compartments-- ----------------------ISize---------------------------- __Liquid dePth--- -------i Capacity----------------------- Field: Distance from nearest`well Distance from foundation----�—Q_r..._.Distance to nearest lot line_---_._J�_..... (� Number of lines_-_._-- ! _____ Length of each line-_-_--3.0- -___�V_..Width of.french-._2_- _- Type of filter material-�rQ.____Depth of filter material--_-, .-Total length____g_____________...�_�__-------- t: Distance to nearest well-__ ___ _F�• __Distance m f undation..._ _ -_ � � � to nearest lot line___.�_.t�.E Size: DieQr istane DerthSf Number of pits......�-------------Lining material` s--- ------_- f---. p Cesspool: Distance from nearest Twell-----------------Distance from foundation-------- -----------Lining material------------------------------------- ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest;well------------------------_--____-_._-. `._-Distance from nearest building----+_------------------------------------- ❑ Distance to nearest lot line--------- -------- - ---------------,--�---{---s-----t- --------------------------------- ----------------------------------------------------------------------- P------------------------------------ Remodeling and/or repairing (describe) 4e4f -- - ---- - -- ------- -- --------------- -------•----------------------- - --------------•--------------------------------•---------------------------•-----------------•--•----- ----- , -P f I •-----•-------•----------- ----------------------------------------------------- t = !-- ------------------ --- - ------------------------------------- ---------- -.--- --------------------•--------------.._. I hereby certify that I have prepared this application and that the.work will be done in accordance with San Joaquin County ordinances, St aws, and rules and regulations-of-the'San Joaquin Local Health'District. era Contractor) (Signed)•---- --------- -- ------ (O n and/or t ctor) --- - �-_,Iiie). ------ y B ------------------------------------ -i---------- ----Y•(Plot plan, showing size of lot, location of system in relation to wells, buildi s,etc., cabe placed on reverse side). -F..FOR DEPARTMENTUSE ONLY , APPLICATION ACCEPTED BY-----------*1_zg7 ------ -- ----� .-- DATE ''� 1-, --------- REVIEWED .SY--------------------- •----------------------------------------- --- DATE---------------------------------------- BUILDING PERMIT ISSUED---------- ---------------------------------------------------------------- DATE.-------- ------ ------------------------- Alterations and/or recommendations:_.__-�.._-_ .__._.. .- _ f.------ � =�'``---`---------- �1.�•_ s--r�i T ��zc -G� t_� .ter �l C -.C'^ -9 ---"�--!"_" 2P'CJ1'- ` ----- ---- - , —�' �- .fir ---------- --- ALT.. ---------------------------------- - ------ - ------------------------------------------------------ ----------- ------------------------------------- -•--------------------------------------------------------------------- -------------- Date ... 1--_ .. _ FINAL INSPECTION BY: --- - ----- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Streef Stockton, California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 31A 3-'63 F.P.CM N