17128 - Laserfiche WebLink

Home Browse Search

----" --- ---------- -.�-�'� APPLICATION FOR SANITATION PERMIT -------- ------------ ------- (Complete in Duplicate) Permit No. ._ _ �.Z �I This Permit Ex ires Z Year From Date Issued u = { This application is hereby made to the San Joaquin Local Health District for a permit t Date Issued � G This application is made in compliance with County Ordinance No. 549. r , f/ / o construct and install the work JOB ADDRESS AND -LOCATION. - k herein described. Owner's Name----_-- '_-------- u _,_ Address -t1---------------- ---- --- - R".,�s� ��'J i _ ----- -------- -- -- --- -_ z z-/ ---------- Contractor's Name_ � n ---- - •-- -�-----.-------____-- �.� Pho - - --- -- _--- G ---- = Phone 7A--: ----•-• _ '�.T - Installation will serve: 'Residencefi- ��par+rnf Ouse - Phone �.� /r k Number of living units: __ / ❑ Commercial ❑ Trailer Court {--- Number of bedrooms ❑ Motel ❑ Other ❑Water Supply: Public.system �---- Number of baths _.�__. Lot size .--- - 1 �J, / -----y,•-•'-- q Community system ___ Character of soil to a depth of 3 feet: Sand ❑ Private ❑ Depth to Water Table �d ` ❑ Gravel -- - ft. Previous Application Made: ate ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ❑ New Construction: Yes ❑ No FHA/VA: Yes [] No (No septic tank or cesspool permitted if public sewer is available within 200 fee ❑ S 9�� Distance from nearest wellt.] Distance from foundation--_------- s Nv. of compartments-------------- ---........Size-------•--------- -- Ma teriaL- ---------------------------•-------- D osal ff --- -- ---Liquid depth------------ F - - - ----. Len th o Capacity ist8nce from nearest welt.' _ _ _ Number of lines__- Distance from foundation I' ---- _ I --. Distance to nearest lot line.---- -_ Type of filter mafierial_ g f each line_- � Depth of filter material:_--,----� �f V✓'dth of trench See a e if: e �T� p Distance to nearest well w I ----Total length_----_---_-_ fi fI J A ----Distance from foundation-- f -`----- Number of pits..-�'---_---_-----_-Lining material--ko p ------Distance to nearest loft line_----- cesspool: Size: Diameter--s �! 'gyp r p Distance from near00 est well----------- --Distance from foundation-_------_ i De fn_ Size: Diameter------------------------------ -_--- Lining material--------------•-- Privy: 6 - ---- Depth---*-------- ---- Liquid Capacity_.--- -- ` est well ------------------ - gals. ❑ +stance from near, -- ---------- - Distance from nearest building -Distance to nearest,;lot line----- ---------- - g------------ --------•--------- ----- -------------- Remodeling-and/or repairing (describe'):---_---- ___ - _______3___________.____ - --- _"-----:,---------------------=--------------------------------------------- ----------- ----- I I hereby certify that I have prepared this application and that the work will be done in accordance with San J ------- ordinances, t e la s, and rules and re ulations of the San :loa uin Local Health District. oaquin Caun# (Signed)-- -_ q Y ---------- ----------------------------------- _ or Contractor] (Plot plan, showing size of lot, location of system in relation #o ells, .b tui dings etc., can be placed on reverse side). deJ. FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED --._- REVIEWED BY-------------- --- J---------------------------- r DATE -•-/ - BUILDING PERMIT ISSUED--------------------- ----- Alteration l`and/or vetend io ---------------------•---------- --------- DATE _t - ... -- ------- v -- --- r ------------------------------------------------ ------------------------------------ ........... .. ------------------------- ----- - ---------- 1NAL INSPECTION BY:..-_-- - � ---- -------- 4? --------------- Date ------ Date ------ --------- ------- - -- -- - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Huxellon Ave, i - - 300 West Oak Street Stockton,California 124 Sycamore Street Lodi, California 205 West 9th Street CS 9 REVISED a-S9 31.1 3-•63 F.P.Ca. Manteca,California TratY,California '