16661 - Laserfiche WebLink

Home Browse Search

I F R OFFICE USE: 3 d ry F/4 410 F3 _ --- ," " �.""-" APPLICATION FOR SANITATION PERMIT Permit No. .,frt.` _ I-._. i -- - _-- (Complete in Duplicate) /" _ __. This Permit Expires 1 Year From Date issued 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 LOC ION � '25 eud _ --------- --------------------6, ---- Owner's Name---------- -- ------------------------------------------ -------- Phone I Address...... - ---- -- - � ------------------•--•------------------ ----•-- - 01 _ � i! --- one.. , Contractor's Name_ Ph 4 Installation will serve: Residence �•]�parfinent House ❑ Com tial PJ.- Water it Court ❑ Motel ❑ Other ❑ �- Lot size --------•---------- ----------- --••---------------------- Number of living units: _____ Nu be of bedrooms ________ Numbo off at Supply: Public!system Community system ❑ Private W-1 epth to Water Table _------ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑IFH�/VA. Yes dobe Hardpan ❑ ' Previous Application Made: (If yes,date......... ...___-.-) No ❑ New Construction: Yes ❑ No E] No E].. } TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank,or cesspool permitted`if public sewer is available within.200 fee+.)- -•-�* Se Ta Distance from nearest well-----------------Distance from foundation-----_--------------Material—__.___._.______._________________....___._. No. of compartments---------- --- -----------Size--------------------------------Liquid depth--------------- ---------(Capacity-----------•-- -------- :4 ------ :4 � / sal Fi I •' Distance from nearest well-_ ...-Distance from foundation___�._0______-Distance to nearest lot line________. Number of lines_______ ........... Length of each line----- -# Width of . + ..r Type of filter material Depth of filter material--------- f___s._Total length_________ _________ 4 1#44 See3a e Pit: Distance to nearest well/,"- _ _Distance om foundation__ ____--- i a e,;o nearest,�lo+"line� _-__ NuNumber of its__- _ Linin material_ Diameter______ _. ..___Dep4( mber Cesspool: Distance from nearest well-----------------_Distance from foundation-- ________--.---- Lin•ing material-----.t.-____.___-.------------_____. ❑ Size: Diameter = Depth. ----- -- ----- -----------------Liquid Capacity- -----------------------4gals. '� Privy: ... .. Distance.from-nearest well-----------------------------I'--------------------Distance fromneai•est building---_------------------ ---------------- � ❑ . Distance to nearest lot line._- ---- ------ l _ ---------------------------------------- - ----------- Remodel .9"and/or repairing (describe)------------- - f ----- -------------------------------------------=------------------------ -- ��'`"�- :---- A , -. ---------------------------- -------------------------------- ----•---._...--•------------------ _ ---------=-------------------•--------------------:------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------- I hereby certify that I have prepared this application and that the work will be done`in accordance with San Joaquin County ordinances, S laws, and rules and regulations of the San Joaquin Local Health District.jf ' 9 [Signe '? ----t—- . ---- ---------------------- ± ( Contractor) k T By:........................------------ ---- - -�--(Ti#le)-------------- ------- -----..------- (Plot plan, showing size of lot, location of system in relation to ells,_buildings, etc!, can be placed on reverse side). l _ FOR DEPARTMENT USE ONLY •" APPLICATION+-ACCEPTED,BY----- --=------ -'w-- ---------- -- ---------------------------------------- DATE - --------- ---------------------------- - REVIEWEDBY------ ---------------------------------- --- --------------------------------- ----------=----------------------------- DATE------=-------------�-----------------------------•------- B111LDFNG PERMIT ISSUED ---- ------- ---- DATE--- -- ` Alterations anid/or recommendations:"_! 1-- --- ------- ...... ---- •--•---------- --- - - ---- -------- - -- --------------- --- . -•-----•-- t .o "-.._-._ - -- / --- - t� Z __________________________________________________________________________________________ --------- _ -------------- ----------- ___._____._..___" - _________________________________________________________________*-.---_.._-___.___..._____._-._.-__-__. ___ -_-_--__._.__.._.__.--____-...__.___.._______.-______.___._.____._.______---_-_---. FINALINSPECTION BY--- -- --- -------- ----------- <` ------------- ------------- Date__/_Z"7 - � ------------------------------------------•- t 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 a-59 3M 3-'63 F.P.DD.