16756 - Laserfiche WebLink

Home Browse Search

FOB OFFICE USE: 1 �I=- 6-'s------ -------l-7- - ------- -------_________ ,_3l1 �� APPLICATL N FOR �'ANITATION PERMIT Permit No. ..... j!`., �.. �". ---------------------- --------.�',�a-�' Complete in Duplicate) r, . Issued - .•- __...__-____-._--_-__.____._____-.--___-____- -- This Permit Expires 1 Year From Date Issued Date ..- 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 Ordnance No. 549. JOB ADDRESS AND CATI N --- a Owner's Name_.. Q ----------- •-- -•------- ,S.c1- -------------- Phone.................................... N Address............................ ----- .l[ty.�5r --------------•--------------------------•---...-----------------------•---•------------ �J ! Contractor's Name-------- -� `....... -----r- _tel -- -------=-------------=----------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commerlial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..._- N ber of bedrooms .�----- Num be of baths ./`____ Lot size �.� ?�___��_�.._j..G„�................. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablees$,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam []• ,Clay ❑ Adobe 2--.-Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New 0,onstruction: Yes Noy❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availabli within 200 feet.) I Septic Ta Distance from nearest well_a_-.^''`y Distance from foundation,_/!;�___-I___-_.Mla�fial_ _ r�_ K __ No. of compartments_____�--_--____Size__ Liqui ep : .�. ":- ;_.Ca acit __ Disposal Field: Distance from nearest well _.____.__ istance from foundation. ,�0__/_.__.Distance to nearest lot line...4.......... 100 Number of lines------------1/___ Length of eaclY'line____� -------------Width of trench--c�Y.�•----------':- -- -,$"4 Type of filter material____/ . ------Depth of filter maTenal__-1X --------Total length.......- l_.A__________________________ � Seepage Pi Distance to nearest well__. tance from f ndation---/10.........Distprice to nearest lot line-,. ------------ �. Number of pits..... ---------------Lining material__YZG __-Size: Diameter_ Dept ----s--- 1h� __.. Cesspool: Distance from nearest well-----------------Distance from foundation__------------------Lining material__.__-__-.____--_._-___-..-_________-. ❑ Size: Diameter--------------------------------------Depth------------------------------I --------------------- --------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building____..___.__.____________--_---__-_-__._. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------,f, f�iN'__- �� % ,�� ----••-- � � ------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- ------- --------------------------------------- -------------------•--------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- -------------------------- ----------------------------------------------------------------------------------------------------------------------------------------:------------ ------------------------- ------ i0 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I /and egulations of the San Joaquin Local Health District. (Signed)__________ ___ '____ ____ _______ (Owner an /or Contractor) lBy:.....--•--------- T 0------•-------------------------------- ( e) {/fit'(Plot plan, showing ation of system in relation to wells, buildings, etc., can-be placed-m.reverseside). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- _ ......................................................... DATE-- 'Z 3------------------------ REVIEWEDBY--------------------------------------------- ------ ----------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------- Altera,r, a or r omm ions:.. --------------------------_______________ -------- -- - ---- �.J--------- ---- ---1.12 --/�� - ----------------;--C-'�------------------------ - ---------------------------------------------------------------------...---- � _ 0 �/,( �-_-.-_ ` .. _.. __ _ ._ _ i_.. 'Y:._ ......5!. ........ ............................................................... 47 FINAL INSPECTION BY:........ ------------------------------------------------------ Date 1 ' SAN JOAQUIN LOCAL HEALTH DISTRICT 4 1604 E.Ha:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ILodi,California Manteca,California Tracy,California Stockton,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.