17652 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --^� -3d Permit No. •�-7�"x-•- !- - APPLICATION FOR SANITATION PERMIT Complete in Duplicate)_. Date Issued ---------- _.---_--__.-_- This permit Expires 1 Year From Date. Issued pp . A lication is hereby made to the San Joaquin Locai Health District for a permit �construct �d install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...-_-.- - Ph w_ ,�j�� . one Owner's Name- -------- ----r----- ----•- ---il r 3'`��' ---- ----- -------------- ------- ------ Address---------- 4 _ t one .� !._.S ------------------------- -------------- -------------------- otPh they ❑ Contractor's Name----------- --•--------•--•---------------------------------------------------------------------- -------•---- - O -'Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Number of living units: __-.I-__ Number of bedrooms ___�.:Number. of baths ,:----- Lot size ------------------------------------ Number Depth to Water Table ------- ft. Water Supply: Public'system [Community system ❑ ❑ Harrigan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam pact olny Yes � Nolay E] Adobe�FHA/VA:�s ❑ No [�' Previous Application Made: (if yes,date-------------- - ----1 No ( New Construction: ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic-tank-or cesspool permitted if public sewer is available within 200 feet.) - 6 Septic T Distance from nearest well-----------------Distance from foundafiiLiquion -_-_-----------Materia------------------------------------------------------------------------- No.-of ---- ------------ --- � No. of compartments---------------------------Size------------------------------- Liquid depth Capacity Distance r Disposal ield /Distance from nearest well-----------------Distance from foundation-- --Width ofttrenchest lot line-_--.---.--^ ---- p ❑ J Number of lines-----:-----•------------- ----Length of each line -.Total .length_-_---_--_----------------------------- - Type of.filter material-,__--._____--.___-`---_Depth of filter material-_____ ------- _______ Distance to nearest well-- Distance m fou dation_rU---------•--.Distance to.nearest lot line_IF Seepaci * _ Depth---------��-- Number of pits------- -------------Lining material------l_----�--- ---Size: Diameter -- - t Lining material---- ------------------------- Cesspool: Distance from nearest well______________'_Distance from foundation--------------------Liquid Capacity_.--------------------------gals. --------- ❑ ' Size: Diameter--1---- ------------------- -------- Depth------------- ------ ------- -------- Distance from :nearest building---------------------- ------------------ Distance from n Privy'.' well----------------------------- - _ , Distance to nearest lot line---------------- ------ --------------- C.c � ---- ----- - ----------------�------ ------ s------------------------ Remodeling and/or repairing (describe) -: ------------------------------------•---------------------------------- -I-i f ---------------=-------------------------------------------------- w 4 -------------- _ -----------------------------------------------------------•------: ---------------------------------------------------- and that ------------------------------------ -t------------------------ ----- .I hereby certify thatI have esaprepnd ared this al olf the San JoaquinhLocal HealtheDistrictn accordance with San Joaquin County ordinances, State laws, a _(Owner and/or Contractor) d --------- --- ----=---------------------- --- --�------ --------------------------------------------------------------------- ------.: ------- ----- (Signe d)------------------------------ ---- le -------------------- ----- -------- ---..- -- -- _ -------------------------------------- (Plot plan, showing size of.lot,.location of..system in relation to wells,.buildings, etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY r t �•-��--------------------------------•--- DATE------'��-�/ -•-------------------=--------- APPLICATION ACCEPTED BY--------- - REVIEWED BY -----------, ----------- ---- ----- DATE---------- --------• ------------------------------- --- DATE ----- 7- ' BUILDING PERMIT ISSUED----------i---------=---------- - -------- Alterations and/or recommendations: _ - , -- - ------------- . �'-------- --�------------------------------ -- i ------------------------------ ------------------- -------- ----------------- ------------------------------I ------------------ ---- '. _.�.. _ FINAL INSPECTION BY:___-.- ----- -------- --- --- ------------------------ S ------•------------- - Date.-. --- - ------ - ' S N JOAQUIN LOCAL HEALTH DISTRICT y 124 sycamore street 205 West 9th Street 1601 E.Haietion Ave, 300 West Oak Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 31A 3-'63 F.P.CO.