18281 - Laserfiche WebLink

Home Browse Search

FOR OFFICE F• xu • � ��-f-��----,.___��-��o;_�_-_ 1�� A PLICATION FOR SANITATION PERMIT c PermitzlSlo. .. L�� 9_4&-4er--------------- --------- ----- (Complete in Duplicate) Date Issued /y 1�7 --------------- This Permit Expires 1 Year From Date Issued . �. t Application is hereby ma a 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 Co nt .5rdipprice No. 549. rr a `. -=---------- 1• J- Z .............. JOB ADDRESS AND LOCATION...._OA�___ t�!_1 ------- Owner's Name---- � -------------- - -------------------------------------------------- -- Phone---------------------_------------- Address------------------------------------C) ---------------------------------------------•---------------------------------------------•--•--------------------------- x ; tom' s Name: = L ; = Phone-------------------------•--------- Contractor 1 Installation will serve: Resiclence?PO'Apartment House El Comm'er'cial ;❑ Trailer Court ❑ Motel ❑ Other ❑ .1 ate--. I Number of livingunits: __ Nu ber of bedrooms -_ Number of baths ___ Lot,size __._ -- ��... f y ----------------- Water Supply: Public system` Community system ❑ Private ❑ Depth to Water Table6.;!"-.ft. Character of soirto Wase h'"of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe ©hardpan ❑ Previous Application Made:!j(If yes,date--------------------) No �ew Construction: Yes ] to❑ FHA/VA: Yes ❑ No k]-- TYPE OF INSTALLATION AND SPECIFICATIONS: +� No septic tank or cess ool ermitted if,public sewer is available within 200 feet.) I A , ,. P . P.- p .�, " .� F M rr Septic Ta ,;Distance from newest.well_____- _. "_Distance from founclation�`�. _M �ial _Cr-_ -ri-C {.; No: of,compa.rfinents____1 .--------_ Size__-- �� _--Ligwd depth:-- ---__,lam C,tapacity--- __---- pi`from nearest wt<II-`._-'k-- '- _._,Distance from foundati n.-��_/__':_.Distance to nearest lot Number -S�J' .Width of trench '--/ ,o# lines--1---- Length of each line_-:_------•-____-- _ � .--- t .:Fa Disposal Field" istance, R �-.v_ Type of.filter;materiar." � :Depfh"of"filter simaterial__jf?X..`..Total length__. ?_________________________ .. Seepage Distance to nearest well "' ;Dista_nce from "at ion __�__' Distance to nearest lot line__r - '�-- - �_ I`umk�er:�of pits_ _�_______ ________Li�img mater al_�-_ _ Size: Diameter .77 - I. = Cesspool: Distance from nearest well_____________. Dista m,foundation-------------_-__.Lining material-_._'--____-_-._-______--_- Size: Diameter- `- .-------- ----------De th---------- --- ------------------------------------Liquid' Capacity ----gals. y❑ " �'' ..Distance from nearest buildin Priv Distance from nearest well.-----'------------------- ❑ ---- - - -- � - ----------- - - -----------------•------ to nearest lot line-'------ ;;--'�--'--- ---- ,------- ---: ��.: :� 9 �descrihe�. --:!!� =f �' . Remodelin and/or re airin --------- 9 p = �; w- .• - i s � . --------------------------------_------------------------------------------------------------------------------------------------------------------------_________----.___, _-_______________ . =__---__________---_____---._.._ - _________________________-________ _ ______________ .._- ______._____._______--:-_____.._._________________.__--__------__--_.._____._____.._____;_.__:___--_;_____- __,i�..__-__.--._____._.____-_....._ I hereby certify that I have preper6d this application and that the work will be done'iin`accoirdance with San,''Joaquip County ordinances, State laws, an rules-and rigul ns of the San Joaquin Local Health District: ; ' --------------------------------------------------------------------- ------- ----------'------ Owner and/or Contractor) By:---.----•----- ------ I Plat plan, showing size of lo------�' `-----'------- � �:t�- --------------------{---' -----(Title--'--�- - - -'- - -r ----- --- - ------------' - - ( p g t, ovation of system in relation to wells, buildings, etc., can bL placed on reverse sicTel. f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. DATE------- ----------- REVIEWEDBY----------------------"--------------'---- --------------------------------------- :----- --------------------------- ----- DATE------- ---------------------------------------------------- BUILDING -------------------- Alterations and/or recommendations•---- i �' S ' D:AT-------------'--- - - ' = BUILDING PERMIT ISSUED-------------------------------------------------------------- ---- r _ s Lr _.. .. �` ' �^ �' ,. __ ` � t C-------- ----------------------------------- •- �� - a�- -!°---- ------------------------------- - ------ �b=�s-------� .. ...-'-� ------------------------ ` -------------- ---------------- ----- --- ---- -- ---- -- =�Z--GS. 4�..+ -----gf-�`�"'-- --- }`---------" _1- ---------------------------- ----------------------------•----- FINAL INSPECTION BY: ,�,---' Date_- =: - -' ---- - ---' ' ------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT .1601 E.Hazelton Ave.' 300 Wet Oak Street' .j 124 Sycamore Street 205 West 91h Street Stockton,California �� Lodi,California Manteca,California Tracy,California F.P.CC. 4 -