16503 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: f, (Complete in Duplicate) --------------------------. J _.. $APPLICATION FOR SANITATION PERMIT Permit No. .. 12��_--- / �- _I/ � _ � Date Issued _______ _ __ _ __ _ This Permit teFrom.Datelssued Application is hereE;y made to the San Joaquin Health Dist -From.-Date or „�,,,,,,;�„-�,,, •,,,��.� a permitito construct and.install the work herein described. This application is made in .compliance with County Ordinan No. 549. ` } JOB ADDRESS A PDCATION -- ----- --------- } ----------- ----- Owner's Name------ ;.--•- -} - --------- .-------------------- - hone_ - --------------- A ----------A �_ Address--------- ----- ----- ------' i Contractor's Name_______________ _ ---------------------- Phone a.:_ .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court C[ Motel ❑ Other f meliving --�_ Number} f bedrooms : m � s. slze � ___________.._ Water Supply: Publics stem Community system Private Depth to Water \ Table;57kj- ft. t % Charade of soil to a depth of 3 feet: Sand [❑ ',Gravel ❑ Sandy Loam El Cay Loam ❑ Clay ❑ Adobe Hardpan ❑ i4 Previous Application Made: [If yes,dote; s _..I' No [-]' New Construction: Yes :❑ NoX FHA/VA: Yes-E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS:` r f (No septic tank or cesspool permitted if public'sewer is available within 200 fee#.)lr 'Sep ' Ta- • Distance from nearest well.................Distance",from foundation________________.:.Material_____.._._._..._...____.._-•__---.---------. No. of compartments-------------------------Size-----------9'-------------------Liquid depth--------------------------Capacity-�. ' '--------------- _ Dis sak field` Distance from ndares# well-_..............Distance from foundation-----------f-------Distance to nearest lot line________----_---- /�gL44J,7 Number of lines.------'-------------------------Length of each line--------------------- --------Width of french------------- ------------___-•. Type of filter material_________________ _____ Depth of filter material_---__-_.----_ ._-_--.Total length_.--------------------�-_________________.. Seepage Pit: Distance #o nearest w0?440.____p Distance r m fo'nda#ion__ ___._.Distance to nearest lot lige---..-_.__ .INumber of pits--*_ _4-.-.--.--_-Lining material_ __:. Size: Diameter_ ..I,/--.__.Depth....... Cesspool: !Distance from nearest well-----------------Distance from foundation-----------.-------Lining material----------------I......-.-----_-_____ Size: Diameter--------------------------------------De th----.------------- ---------I-------Liquid Capacity L ------gals. Privy: Distance from nearest well__ __>_._._K__________________________..-- ::.Distance from-nearestbuilding---_______-____ -------------------- ❑ ;Distance to nearest lot line ---------------------------�------- ----�__.-�� ---_-_--- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------••---------------------------- ---------7---------------- --• ' _c -------------------------------•-------•-----------•-------------------------------------------------------------------------------------------------------------------------------------------------------:----------------- A ---------------------_•-__-__--_.__-._------_.-_------_________-______-----__..____-_-_-____--._--_---------__-..__---_-__----__--.__-----______-__---__-_---.-.-_-_----_-_---____-_--___-___----___----_-:_':_-----_-.--.-.-... I hereby certify that I-have"prepared this application and that the work will be done'in accordance with San Joaquin County " { ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ..,0 ----------- �� '� ------ - caner and/or Contractor] BY=---------- -------- ---------(Title} ------ -------------------------------- 0 ----------------------- - - (Plot pian, showing siie of lot, location of system in relation to Is, buildings, etc., can be placed on reverse side). T ; 17 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.------ [ ----------------------------------------------------------- DATE-------- le-_ f`� REVIEWEDBY----1----------------------------- - ---------'---------------------------------.------------------------------------------- DATE----------------------------------- � BUILDING PERMIT ISSUED------------------------- ------------------------------------_---------=- -------------------------- DATE---------------=--------------------------------------------- Alterations d and/or recommendafons:._ -- -- - -------------------------------------•-------------------------------•-------•--•------••--------•------------------- => a.y _- -- ------------------------------ ------------- ---------------------------------------------------------------------- --------------------------------------------------------------- ---------------- ---------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ------------------------------ FINAL INSPECTION BY:------- L "----- ----•---------------- Date-.----- -- ...� .--•---�'�--------- ------ 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 B-59 3M 3-'63 F.P.CO.