17155 - Laserfiche WebLink

Home Browse Search

-FOIZ OFFICE USE: ' ---- 3------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No ....7..........S (Complete in Duplicate) 3 ------ --------------------------- ------- 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. JOB ADDRESS AND LOCATION-----9.59---------Ay W--- ------ =--------------='---------------"f�T�FRL?p-=-------------_ ------- Owners Name_____________ - ------ Phone—---=----------------- - - Address b ' ------. Contractor's Name t - T aW ------------------=---- Phone. 11 Installation will serve: Residen e [ Apartment House [ICommercial ❑ Trailer Court [IMotel [IOther,❑ Number of living units: _VCO �__ Number oftbeed o'oms umber of baths __.1___ Lot size ___ - _.f R ---------------=- Water Supply: Public systemmmun,ty system ❑ Private ❑ Depth to.Water Table__. --- ft. Character of soil to a depth of 3 feet: Sand [ Graveltn Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ �Ne<133 /.Previous Application Made: (If yes,date__._-:- ) 1Noonstruction: Yess jj,- o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Mile " ( ptipool P_ No se c tank or cesspool ermitted if public sewer-is available withini(200 feet.) -.. Septic Tank: Distance from nearest well-----------------Distance from foundatio Material_- T ---. rxif T/VNI(9- No. of compartments_ _ -__._:Size __ Liquid depth .------------------. _ Capacity_____ _.._' L j� f �Tiq K Off t T # Disposal Fi'old: Distance rom Heaves well �..-_-_Distance from fou.ndat,on.___. ____.__.Distance to nearest lot line__ Number of lines________ _ _ gth of each line _E_ z _____ ___-Width of trench_- 2 �`..__ ---------- Len�X T(�C— Type of filter.material.._ _Depth of filter material-----� __�_`. Tofal length----------------- Z--------------- ADD: ____----_- e�, t _..Distance to nearest lot line _ SeepagerPit: Distance to nearest well_._ �4�_____Distance from foundation____ _�_ Number of pits..._ _ __ _ ` fl_cy.Size: Diameter__ ) ��__-_Depth - 6 ------------------ Lining mater,aL_ _. __ __ ! Cesspool: Distance from nearest well---------------- Distance from fouundatio:n _- Lining_material-..- _--__ _-___________----- ❑ Size: Diameter--------------------------------------Deptth----------------------------- - - Liquid Cap tY gals. Privy: Distance from nearest well. ___-.-_ -------------------- Distance from nearest budding __ ___ _ __ __ ____ _ ___ AjPn ❑ Distance to nearest lot line------------------------ - -----------------------------------------------' 0 Remodeling and/or repairing (describe):----------------------1 -- ------------------ - -- ----------------- --- ------ ---- --------------- ------ ----- --------- - --- ---- - ---------- --- - --- --- -- -- ---- ----- ---- ----------- ---------------------------- -- -- - --- --------- -- - -- ---- - ------------------------ ,. .. �, .�:,+�....... » »,.,*--. i I hereby certify that I heveprepared this application and that 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.. (Signed)- !/)e4# ------------------------------------ --- _(Ocaner anorontract Contractor) --7 y ---•--------------- -----� ---------- --------------7 ---- --- - -- ----- --- --- -- -- ---- -- (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 / V- - ------ DATE- ----_ 'l_� ' ------ APPLICATION ACCEPTED BY__ _��__�-=- ------- --- -- ----- ------ ----- --- REVIEWEDBY------------------------------------- �. DATE---------------------------------------------------------- BUILDING PERMIT ISSUED- =` = DATE- -- Alterations and/or recommendations: --' - ----------- _ A � __ - t ' s 1 FINAL INSPECTI 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 5-59 3M 3-'63 F.F.CD. k1_