19493 - Laserfiche WebLink

Home Browse Search

1-UN Ui-HCE USE: - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No,---- -..3 _.. (Complete in Duplicate) --------------- -- This Permit Ex ires ] Year From Date Issued Dote Issued ... - A PPlication is hereby rnade to the San Joaquin Local Health District for a permit to construct and install the work herei9descri5ed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESSYAN LOCATION_Z _- - t Owners Name -._--__-__ ---------- -•--• Phone- -------=------- ---•----• Address........ S?-K f-. 4 -------------- ---- - -- • ---- yW_...........................------------------� Contractor's Name - _-- - I----- ---- _ .............. -... Phoneg:.�_7---.F.. Installation will serve: Residence Apartment House cc mmarci jTraiie Court ❑ otel ❑;� er—[] E. _ Number of living units: __ ---- Number of bedrooms __'� Number of ba#hs:�-`,_ Lot.size__ Water Supply: Public system ❑ 'Qoimmunity'system ❑ Private Depth To Water Fable-�_—_o ft`- Character of soil to a'depth of 3 fee�Sand ❑ .Gravel_❑--"'Sandy'Loam L] Clay Loam Clay ❑ Adobe❑ Hardpan ❑ I ; Previous Application Made: llf yes,date----:-__-.----------) NONJ New Construction: Yes ❑ N04 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tanVor cesspool permitted if'public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellDistance from foundation__'"-.Material------------------ ................--------------- ❑ No. of compartments--------------------------Size........ -----------------------Liquid depth---- ---------------------Capacity-•-•-- Disposal- Field: Distance from nearest well-:- -.-.-Distance from fou dati�___.10._.....Distance to nearest lot lii6el_5_0 Number of lines_- ..-_- -- ength of each,1ine--------T4...-l---_-_--_.Width of trench---a- Type of filter materia] :�_V4� epth !of-filter material_-.-129_ I Total length Q---------------------------- --- ................ Seepage Pit: Distance to nearest well__��5__---- --_bistance from' oundation__1 qo__--___.Distance to nearest lot ling-4_r-� .......... Number of pits------/------------Lining material-_-M Size: Diameter---W_'l—--------Depth:_/-1_ ------------- i Cesspool: Distance from nearest well-------- --------Distaryce from foundation--------------------Lining material----:: ------------------...... Liquid Capacity r— Depth : 4 P tY :---•------------•-------gals. Size: Diameter--------•--------------- ----------- Privy: Distance from nearest well- ---__` - ---------- ---------- -----_Distance from nearest building-----------.----____----_ Distanceto nearest lot line ------------------z-----------------------------•----•-----------------•--*---•----------------------------------------------------- Remodelin and/or repairi (describe):_- _ "f � -4f -•--•--------• :i------- `• •------ ------- N -------------•---------------------•- ---•--•-•----...._.. -------------------------------------------- --•----•-----------------------------•------•-----------------------------------------------------------•---•- .................................-----•--------•-------•--------------------------- I hereby certify that I have prepared this applica+ion and that.fhe work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of fly San Joaquin'.Local Health District, (Signed)--- ---- ----- -- ------ '-- '• f ` ---- t ------ -----------------•----- ---------------------.(Owner and/or Contractor) Plot Ian, showing of lot, location#s + m m relation to wells, b t (rtle)-- • ---- -- -- ----------- -- ( p 9 y uildings, a+c., can be placed n reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------`- ----- ---------- ------ ----- ----------- ---------- -------- -- DATE------ REVIEWED BY--------------------------------- = ' 1 , DATE_ # ---------------------------------- _-._-_-------------------------------•- BUILDING PERMIT ISSUED_ - - `-------------------------'--- - ----------N-------------- DATE Alterations and/or recommendations:- -.' -tel-T-�' •_ -------•----------- -----------------•--••------------•--•--------------- =------------------------- lh: ' �S/ _, .. }, 4T 1>-----------------------..........-------- -------•- 1� 4y R i ; W -----------------------------------------------••--------" -"--- - --- ----------------------- _------- -__-----_-__-•-_-----------.--_---_------------------------_-----•--------_-------_---_------_-.....-. ♦ r, el FINAL INSPECT I�]i�B - � -- -_ Date , -= -- -----------•---- ---------------------------- SAN JOAQUIN^LOCAL HEALTH DISTRICT 130 South Amirican Street 300 Wert Oak Street * 124 Sycamore Street 205 West 9th Street Stockton,CaliFornla Lodi,Californi.o Manteca,California Tracy,California ES 9 REVISED 6.59 2M 5-62 ATLAS -" -