17775 - Laserfiche WebLink

Home Browse Search

_. _ .. M,A, •� _ FOR OFFICE USE. sv )s� �� 5 ----------------- " APPLICATION SANITATION PERMIT Permit No. •.-.- -------- � /i_4- "" (Complete in Duplicate) Date issued .__._�1-- ------"--""------------ ------ " " This Permit Ex ices 1 Year From Date Issued + - ------------------------------ -- ------------ ------- 1 Application is hereby made to the San Joaquin Local Health District for o a permit to construct and the work herein descr e . Thisapplication is made in compliance wit�`CSo�u¢t/yI SnG -------- JOB ADDRESS AND L CATION_. . _— Phone-------------------------------•---- ---------- Owner s Name---- -------•-' : .- ---- •------ � i - �--- ------------------------- � �-- ----- ------ - Address - one - ---- -------------- ee Contractor's Name____.___•_____________ _ Motel ❑ Other ❑ Apartment House ❑ Commercial ❑ Tia ii er Court ❑ Installation will serve: Residence AP � ". -•_____________ _________ ; , ,�__ Numbe;"of bathsy__�__:��Lot isize --------- Number of living units: __. ___ Number of bedrooms Private Depth to Water Table ft. Water Supply: Public system ❑ Community syst ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: ?Sand Gravel [ISand Loam C3Clay Loam ❑ NColay ❑FHA/VA:�s ❑ No ©� Previous Application Made: (If yes date--------------------) No New Construction: Yes to E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Material - r i Septic Ta Distance from nearest well__------Distance from found fiiLiqu _ - Ca pacify � �.. �" �_ -----size__ ��K�---�;Q--=--•Liquid depth---- �-- - -- -- P Y----- ----- � L� No. of compartments_____________ _ _ ! field: Distance from nearest well 10. from foundation �8-�- WEd h aftfre chst--l$lot in Disposal Length of each line__-______. �--- Number. of lines_---------- ----- g I _ of 1 le h----� ='_•��_ � I t kr ,8�PQ' Type of filter materiae e41�Depth of filter material____ l Seepage Pit: Distance to nearest well-------- from foundation____-_________-__-.Distance #o nearest lot line_____________-__ Number of pits Lining material----------- - --.Size: Diameter------=------- -----Depth ---- --------:----------------- 100 ❑ Distance from nearest well_________________Distance from foundation__.-.--------- Liquid Capacity_ gals. A Cesspool: _ g P Y-- ------------- --------- � l ❑ Size: Diameter------------------------------------Depth------------------------------ ----------- ------- Distance from nearest building--.-------- ------------------------------- Privy: Distance from nearest,well_..___-- ___-__-_-_____ ---- ------------- -------------------------- ❑ Distance to nearest lot. fine._______._.._-______-- ' Remodeling and/or repairing Jdescribe) '------- ---------------------------------------- - -------------•-----------•-------------------------------- --- = -------------- y----•- -----------------------------•----------------------------------- ;� ------------------------ - + s": ^x l ---- ------------- --------------- ---- ----------------------------------' -----------------------------(------------------------ = -v I hereby 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 regulations o the San Joaquin Local Health District. l7l a - (Owne?;arid%r ) Contractor 5i CJ` r (Signed) --- 9 k ------------------(Title ------ - ----------------------------------------------------------- --- buildings, etc., can be,placed. on.:-reyeise side). i (Plot plan, showing size of lot, location of system in relation to wellE, FOR DEPARTMENT USE ONLY '`' DATE ± �� 74------------------------------ i -----------------` -_"_�.� APPLICATION ACCEPTED BY____.._ -_ - =--------- - DAT ---------- ----•---I--------- - REVIEWED BY ; DATE - - - ------------------ : .: BUILDING PERMIT ISSUED__.:___.._•,---"---- .t, 9, l' Alteratio,s and/or recommendati ns: = =:: ¢ _, ; ` `- ------------------------------------ �Z. � - -- -- / ..w i " e OF __".-: ------------------------- ------------------------------------ --- i { v. ------------ ------------------- ---------- ' I �. --�- ---- ------------------------------------ -------------. c _ Date.rt } FINAL INSPECTION BY--------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Are. 300 West Oak Street ]24 Sycamore Street 205West 9th Street i, Lodi,California a,C Man alifornia Tracy,California Stockton,California FS 9 REVISED 9-59 3M 3-'63 F.P.CC.