17168 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ C 1 := 3/x ---- -------- ---------------------- ff APPLICATION FOR SANITATION PERMIT Permit No. ..... -------- -------- - ---- (Complete in Duplicate) _ .3�. Date Issued This Permit Expires l_Year From Date Issued 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 Ordinance No. 549. ty5 t _ JOB ADDRESS A L AT10N - ----------- -1---- - --�� C�`Cl.�-t ----------------------- Owner's Name_ f- ' 1v _- --------------------------- Phone Address------------------------� _da�L ----- 5'_ -= Cc 4_j.0 ! J ------------------------------------------------------------ , Contractors Name. Phone Installation will serve: ResiclencIllii,-TJ�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ Number of bedrooms �.�L ^ "---- Number of baths _ ____-- of size --__-_--_ _-- 7�__.11.5--------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water TableGc_'__�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am E] Clay foam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date____________________l :No. New Construction: Yes ❑ No [. HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet,) " Septic Tank: Distance from nearest well________________Distance from foundation------------- Material-----------------------------------.__ _..______- ❑ No. of compartments---------------------------Size---------------------------------Liquid depth--------------------------Capacity-------------------- Disposal Id: Distance from nearest we31....Lr___Distantefrom foundation___/l'__ _'_._.Distance to nearest lot ------ W Number of lines_=_:'"T -----------------------Length bt each line--------,t --------- Width of trench-- - ------•-------_---------- / Ur of filter material_�� __.._____. _Depth of fiber material___� ______-------Total. length________ ___________--___-.-__._ ___..__Linin material 11__...Size: Diameter-*?ter_*? !�----___Depth t lot line_ y ------ 6- 19r$eepag It: Distance topnearest ell-,--~✓�-__Distance from foundation-� Distance to nearest Number of its--------,f - - Cesspool: Distance from nearest well______._:~-_Distance from foundation.-_._--�-_.__�_-__.Lining material--------r -- --------- ------------ ❑ Size: Diameter-------------------- --------- Depth-- :f ---------- ---Liquid Capacity----------------------------gals. Privy: Distance from.nearest,well-----------------------------------------------."Distance from nearest building-------------------------------________._. , ❑ Distance to nearest'lot line------------ - ----- ------ ------------'-- ----------- ------------------------------------------------------- Remo deling ------------------------- --------------------------Remodeling and/or repairing (describe}:----- + -------------------------------- l t f ------------------- ---------------- -----------------------------------------------------------•-.---------------- ------------------------------------------------------------------------- ----------------------------------------------------- - - P ------------------------------------�---------------------------k----- i I hereby certify#ka I have prep IN application and that the work will be done:in accordance with San Joaquin County ordinances, State la a rules u tions of the San Joaquin Local Health District. F (SignedI------------ ---(�-- -----____-- P. ---- ----` -- {Owner ani/ r Contractor) ------------------------ -------- - ---- ---------- --- --- -- --- By:-------=--- --------------- .._ ----- ---- —---------- --------- ----------{------------------------(Title) (Plot plan, showing size of, location of.systerh in relation to wells, buildings, etc., cart be p ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --------------------------------------------------------------- DATE-------- --------------------------- T K REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ ----•- ------------------ ------------------ DATE-_-------- ----- ' BUILDING PERMIT ISSUED-------------------------------------------------------------- DATE------------------------------------------------------------- ..-_, �- Alterations and/or recommendations:__.______".____._ ;' - r ------ -- ------------------•--- ---- ZZ,4 dry✓_. - f ----`- ----- --- - � J ---------------------------- ---- - - - --- -- ------------ -- .�- FINAL INSPECTION BY:.------.. Date-_----..-- '. �:.' ------ ------ ----------------- ---------- "�" � ~SAN JOAQUIN LOCAL HEALTH DISTRICT 16" E.Ha:alto.Ave, i00 West Oak Street �s 124 Sycamore Street 205 West 9th Street a Stockton,California Lodi,California Manteca; California Tracy,Californio rS 9 REVISED S-59 3M 3-'63 F.P.00. -