17437 - Laserfiche WebLink

Home Browse Search

t-UK UYrl k USt: ._____.___________---------------------------_____ _ 1 APPLICATION FOR SANITATION PERMIT Permit No. .�F-4 _ _ (Complete-in Duplicate). ....�..,y I .._. . ._ -� - Date issued This Permit Ex .fres 1 Year From Date Issued y Application is hereby made to the San Joaquin Local Health District for a permit to construct 06 the work herein described. j This application is made in co m liance with County Ordinance No. 549.-THIAb 44 z JOB ADDRESS AND L ATION_.-_____"_____ S l D� _- ---�----- ------------ -5�----- �r-=-- -- -------QTR�•�--`r------ •--•- Owne�'s Name- -- - # A► .1 '-.- �1�4_ 1T =' _ � - ----- -------=--- Phone-------------- --=--------=-------h Address----------- :e..:__I !' _. ' I ,Cont = = ----------�--- -- - ----- actors Name' �.__ - ----•--------------••----------------•-----._.....-----, - -- ` Ift7 --- •-------•-. Phone-------------------------- Installation --� - 4. Installation will serve: 'Residence [�Aparfinent Hous::�.Com- mm cal--Ej-Tra�ile Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms._ Number of baths f.____. Lof siI . ze ________ __ - ` 'Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ _ ft. .Character'of soil to a depth of!3 feet: ; Sand Gravel S d Loam Clay L t h R ❑, Y ❑ y m ❑ Clay ❑ Adobe ❑ Hardpan ❑ F Previous Application Made: (if,yes,da4e_.._____..__ .._._.) No New Cons+ruction; Yes Er No ❑ FHA/VA: Yes ❑ No �~ !TYPE-OF INSTALLATION AND SPECIFICATIONS: �. - P- f_(No septic.tank.or cesspool permitted. If-public-sewer is-available within 200 feet.);. . _a'Y No. of com artments____ -- __ - --X- Y Liquid dr --Mage t eptic nk: Distance fr� nea�sf wel�`- Sizeance from foundation---- --- epth__��Z,__--.____"Capacity__:�«��_"�-- t Ir Disposal Field: Distance from nearest well-a =-Distance from foundation____-_0 Distance to nearest lot lig9__5 Number of lines______. ' ------------:-----------Length of each line---- -a`_. -6_4-3C?�/ti/idth of french_-----.r��'--:��------- T e of fi#t material- RQC_ "-- ------ - - YP t. Depth of.filter material ----� :-- --_Total length----------/_2Q------------------- Pit: -----_-__-- !� ; t ------ �. !Seepage Pif: Distance to nearest well_____.________-______Distance from foundation__-_____ -_"_.__.Distance to nearest lot line______ ! ❑ Number of Pifs---f--":�.�,.."r.Liningrmateirial .�« ---------- i . . Size? Diafneier Depth 1 Cesspool: Distance from ne#a est well_______________DIstance from foundafion-...__��_________-LirWngfmaterial______________""___.________-----"- S ❑ Size: Diameter - ----------- ----- ------ Depth-------------------- Liquid Capacity gals. ` Priv lr i .I � i f.,- -- -------------------- y: Distance from nee#est well-----------------------------------------------1--pista�ce from. nearesf.building- ---------------------------------- Distance❑ to nearest-. lot line----- -- ----- ------"--- ---- - ------_ gi` Remodeling and/or repairing (destcr_;-I t)--------------- ----- =;.. .. - 4 »44V ---------- --------------------- I _ _ - i ----------------------------- t --------------- --------------------------- ----------------------- I hereby certify that I have Qrepared this application and that the work will be donelin accordance with San Joaquin County ordinances, Stere-la s, and rules n IrWjthe San Joa uin Local Health Di df. Sr ned{ 9 r1 i`= - - ------------------------------------------------I -------- (Owner and/or Contractor) - - _ By:r---------------------------•-- pt - +3 eft k (Title) ----------------------------------- Plat plan, showing size of lot, location ofs stemin relatron to wells, Buildings, a+c. can be placed on reverse` `side).�"'� `' , _ s = FOR DEPARTMENT USE ONLY p E APPLICATION ACCEPTED BY _ '�-ER Q -------------'----------------------------------- -------------------- DATE---- � 0 T REVIEWED BY ------------------ . 1::-I=-----------------------------' --------------•--"-------- -. ._ ------ DATEa__ _BUILDING,PERMIT ISSUED :-- J - -= =------- - ------- DATE AI#era'tions`and/orrecommendations ` :-. -y go ,y -r - -=--- - - - ------ ---- _____________________.. ___._._...______..__------------------------------------------------ _______________________ _ it "__________________ .__..------------------- ----------------------------------------------------- SPINAL INSPECT N BY. f�.y�,��nn �` Date_ Z ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. Y 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ;ES 9 REv16ED B-59 3M 3-'63 F.F.CO. r-