17191 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 117/ IF/ --------------------------------------------------------- Permit No. - ---------------------------- ------------------------ APPLICATION FOR SANITATION PERMIT (Com --------------- ----__-- _ I--- -------- --------- ---------- plete in Duplicate) Date Issued ... .�.� l/- 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 thew k herein tgdciribed. This application is made in compliance w;i�}i� un Ordinance No. 549. E iC JOB ADDRESS AND LOCATION------ ---- -- -- -------1 ---------------- ?------..---- Owner's Name---------�------/ - ----•------------------------------------- -;-------------------------------- Phone.................................... Address---------------- 8-4--,50.:2------•--...-•---------------- ----------------------------------------------------------------------- Contractor's Name------ 4Z _1 *=-•-•r• . ----------•--------------------•-------------------------------------- Phone-041.4 Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..yNumber of bedrooms _ _ Number of baths -Z Lot size ------- W4Ae � -- --=-=-------------------------- Water Supply: Public system ❑ Community system ❑ 'Private Depth to Water Table 4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam A Clay Loam r'O' Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date._.------...........) No$ New Construction: Yesb' No ❑ FHA/VA:Yes ❑ NSX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--_�Q�---DistanceLfrom foundation----I4._.._______.Mater' __�4----K --------------- 'A No. of compartments....___.. ---Liquid de th_.-___?"�______--Ca acit ,/ Disposal Field: Distance from nearest well-6-6.....Distance from foundation-___Z-Q---------Distance to nearest lot Number of lines..........,rte.__________-------Length of each line__1�d__'_ :S_�.Width of trench------ "_______ _______ Type of filter materials__��I�-__Depth of filter material______/( '------Total length-------------fs �___.._ ______---r Seepage Pit: Distance to nearest well---f0�_'___-___Distance from foundation---,l40_....._...Distance to nearest lot line-__(,��..__.. ` Number of pits------.________Lining materiaLz.�A1 !<_..Size: Diameter-------cV... Depth------------Z S`-........... �p Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 0 Size: Diameter------------- ------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building____._____.__-._______-__-----._______-__. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------- ----------------------------------------- Remodeling and/or repairing (describe):........ sem.- -f ? -_ -- -- r =' ------------------------------------------------------------------------------------ ---------------------------------------•---------- ------------------------------------------------------------------------------------- ------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- •-----------•---- -- ------------------- ------------------------------------------------------------- -- I hereby certify that I have prepared this application and Aat the work will be-done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. tSE�!� (Ow er and/or Contractor) (Signed)------------ - - / s r ,a�� - rale By:------------------ --- -------- ` -------- ----------------------------------( )- - - --- ---- (Plot plan, showing size of lot, location of system in 4a ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY TR' C � DATE - - ------------------------- REVIEWEDBY----------------- . DATE--------------------------------- - BUILDING PERMIT ISSUED - ------------------------- ---------------------------------t._. DATE Alterations and/or recommendations:....�-______ T-___ P_ f k_ ----------;;�75............ Q.......... ---=______ --------------- ---------------- --------------- -----------------------------------------------------------------------f-------------------------------------------------- t _( . -------------- -7--V-7. �!----K---- -�_-----------/.S_T.....------AF•---- ....... ---------------------------------------- ------------- - -- - ---------------------------------------------------------------------------------------- ------------- FINAL '1NSPECTIO Date-----------------Y- "� ---------------------------- 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 E5 9 REVISED S-59 3M 3-'63 F.F.CD.