17317 - Laserfiche WebLink

Home Browse Search

It Urrlc;t USE: `�� • �� - - - °__-... APPLICATION FOR SANITATION PERMIT Permit No. :'�--- -- - ' =-----" Com Iete,.in Du licate F This Permit Expires 1 Year From Date Issued Dote'"lssued"4-___:.__ _-•-.---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des This applica#ion is made in compliance with County Ordinance No. 549. ibed. I t JOB ADDRESS AND LOCATION-_ _--_::�_J_� ,s a--- Owne 's Name ^. ------------- ap_/ �---•---- --- _.. _.;_ -- --------------- Phone----------------------=----------- Address------------ `Z= ---------------••--------------------------•----------------- ----------•--•-------------------------- ---------- Contractor's Name-------------------------- --------------------------------------------------------------- Phone_.YC;_Y_s `? ' Installation will serve: Residence �+ Apartment House E] Commercial [:1 Trailer Court E] Motel ❑ Other ❑ ! I Numberrof liyirig,units: j----- Number of bedrooms ---k__ Number of baths __I___- Lot size ---->e� _�_r�-�Q -------------- ------- Watei Supply: Publac..s�yste Community system ❑ Private [❑ fDept}i,}67Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Cla Adobe e a. _ Y ❑ y ❑ Hardpan ❑ Previous Application ,Made: (If yes,date--------------------) -No ] New ConstruefiAn: Yes ❑ No 0--�. FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank'or cespool permitted if public sewer is available within 200 feet.) - w Septic ank: Distance from nearest well----------------- fromfoundation--__-_._-__..____-.Materiaf_____...F__-__.__ } Nc. of compartments--------------------------Size-----•------ F t, r Liquid depth--------- -------------- Capacity----------#-------- Disposal field: Distance from nearest well_Ao;t�__C`Distance from foundation-----t*0---------Distance to nearest lot ®^ Number of'lines__yf.__ Length of:each lin _f)ffX .4f Width,of french "-JL-.------ --- _ .,..:..�.�.,�,,Type.:of.filter.material-.._R!6A L "__-Depth.of-filter. /i__`_�M__------Total length___.__G_5�.�__-_-, ---- Seepage Pit- Distance to nearestwell__IY� _V _ Distance from foundation__-_ Distance"tooriearest lot line_" . Number of pits _f - _Lining material-' tri -_..Size: Diameter__. 2-�'. S0. s'Z W Cesspool: Distance from nearest well_________________Distance from foundation.______- .Lining maferial---------------__-----_-(- ize: ,ame er ---'Depth------------------------------------ ------- ---- Liquid Capacity = gals. ' Privy:3 Distance from nearest well___ ___________ __________:_____i __:---__ stance from neares.t.buildin i ' ' g ------- Distance ❑ to nearest'loft line - --'---- --:--- ---- --" fl/ - ---- ---------- ------------- -- 1 Remotdeling and/or repairing (describe')_____________________ -------------: --------- 1 = 1_ - = --------------------------------------------------- -------•-... -=----•-------•----•) r f y __ _________________________________________________ 7 r, ________________�'___---_.. i , I _______________________________________________________________,,____..______________..________.._____.._________"_-------___.-_._-____--_._--___O__'_____-..--____.--___----_.____...._ � 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 5!f the San Joaquin Local Health District. (Signed)---------- ► 1 a { Contractor)t C I •.._ - ------------ -.-.-.Owner and/or on ac#or') By=------ f } T -�- - -------------- - --- -(rifle) (Plot plan, showing size of lot, location of system in,relation ao wells„buildings,.,etc.,rcan.be placed on reverse side). t - t FOR'DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY------ .--- -. __ } ----------------------------------------------- DATE .' , _-_ ' REVIEWED BY-------------I-- ;- .' i ----- ------ . DATE ------------------------------------- 1 ------- BUILDING PERMIT ISSUED --"----------- --- ---- D/�TE. _ Alterations and/ r r co mendations__#1_ I -. --- "f - ,-�3G '` ---------------------- --------- _k.:w I ---- --------------- -- - - ------- ---------{--------------- r ; '6 -..._ � Wit, �` ' s = - -- __ c�'P b ;.`��, Date - ^- - FINAL INSPECTION BY:------------ -- -- -------------- ------- IL SAN JOAQUIN LOCAL HEALTH DISTRICT 4` 1401 1.Haxelton Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California �: Lodi,California Manteca,California Tracy,California.. _ _..I - -4 E5 3 REVISED H-S9 3M 3-'63 C F.P. D. � i� j