17441 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - I ---- ------------------------------------------------------ Permit Na. _ ----------- --------------------------------------------- APPLICATION FOR SANITATION PERMIT =------------ (Complete in Duplicate} Date IssuedS"'t X�. ___---_---- This Permit Expires 1 Year From Date Issued e ------ --- ------ --- ------------------- -: 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 wit}i County Ordinance No. 549. 1 4 JOB ADDRESS AND LOCATION----/ 33......9.43_ }_L-._ - �` `� --------------- R.l ,------------------------ ? rjjyy r ------ Owner's Name-_ fit —_------ _�- ------------------------------------------------ Pone Address-------- PTf-_ "� A: l — ------A1V_�- -=-==-�-1:1 l `------------------------------------ 0r)( ,Z. l-3[ ;I� Name----------Ot1C]_��:.�------------------==�__=-==-=`-------------------------------------- -------•------ = Phone :...------------------------- Contractor's Installation will serve: Residence Ef[' Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Ofheir,❑ Number of living units: _____ Number f bedrooms __ . Num _-`Number of baths --- Lot size --___/_ ----------- ------- Wate} Supply: Public system ❑ Communty:system l❑d Private .M/-Depth�to Water Table __ ft. Character of soil to a depth o#3 feet: Sand Gravel ❑ Sandy Loam ❑ GlSy Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: 11f yes,date--------------------I No Z� New Construction: Yes P-'No E] FHA/VA: Yes ❑ No a ' TY_PE,OF INSTALLATION AND SPECIFICATIONS: No ae tic tank or cesspool permitted if public sewer is ova table wi4hin 2 -feet.) r ce'from funatio _Distance from nearest well__. -__'_Distan _._.__. .MatSeptic ank: en k No. of compartments ------------Size_�Y - Liquid'•depth----- ---- --- Capacity---< � ___ p Number of lines___.______....--------_--------Length of each line_ � -- �a -•--Dista rice to nearest lin��._�+_�.. . Disposal Field: Distance from nearest well-__�_�.,'____Distance from foundation! I-�"width of trench__..___GZ.�-______________..___ Type of filter material---iRO-C-�------Depth of filter material'__ _ _ __________Total length-------------------- �►i Number of pits.-.______.___.______Lining material Size: Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well-------------------- Dista fromoundationDiameter____.__.__.____- Depth_____________________.______.__ Q ❑ �'"` pistance from foundation--------------- Linin material__----_--_-_.--__._-----_-_-_-_-._. Cesspool: Distance from nearest wet!______________ _� x ---- 9 El Size: Diameter. -------_-_ "- -'.------Depth-"------------------------ -__1----------------------Liquid Capacity- ----------•-----------gals. 0.1 .e6re s :-Distance from nearest building -----. Privy: Distance�from`nearest we{I------------------------------------------------- 9------ ------------ ----•------- - [� Distance.to nearest lot line------------------------------------------------------------------------------ ----------------------------------------- ... Remoeiing and/or repairing'(describe):------- -----------------------------?,---------------------------------------------------------------------------------------------------•--------- Ib r -------- -------- •----- ------------------------------------------------ ------------------------------------------_------------------------------------------------------------------------------------------------------------------ I1hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin local Health District. in (Signe ---- ---- ---- --------------------- --- ----------------- ------ -- caer adrContractor) - - :--. ----- --------------------- - _-(.Title)__ _ `'�-::- _'.�:.:,• .,.w.:,,�-�- (Plot plan, sh ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). . f � FOR DEPARTMENT USE ONLY ` C " APPLICATIONACCEPTED BY-' t_ xQ`------------------------------------------------------------------------ DATE------ -� =-- -------------------------- REVIEWED`�BY--=-----------^ �___--_------------- ------------- ---------------------------------------------- ---------------------- DATE:-------- - '------- --------------- s -- BUILDINGIPERkTISSUED------------------------------------- --- ----------------•-------------:-------:------------------- DATE---------------------------------- -------------------- PC ------ 1 Alterations,and orecommendations: 1-LQ - _ ? - . },,w %L ---------- -------------------------•----------------------- ----------------------w--------------------------- ------------------------ --------- ---------------------- ------ -- . �." - ----------------"--------- ----------------------•-------•----------- -•------- ----------------.--4---- -------------- ------ - _ . -- `" = ------------------------------------------------------------ ---------------- -------- -------- ------ ---- ------------ ---- - - FINAL INSPECfl B 7 1�--- ------ - ---- -.---- Date------- ------=---------- --" Y ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California 3' E6 9 REVISED B-59 3M 3-'63 F.F.Da- -