17643 - Laserfiche WebLink

Home Browse Search

FQR OFFICE USE: --------- --- ____ �--- a APPLICATIONF01kcSANITATION PERMIT Permit No. /(��--------------------=- (Complete in Duplicate] / { / ------------ ---- -- -------------- This Permit Expires 1 Year From Date Issued Date Issued Applica+ion 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. JOB ADDRESS AND LOCATION......- - _ 4_7? Owner's Name------- � ------------------_------------IV----------- ------------------------ -------------- Phone---------------.---- Address-----------Jf_-- 4 - e�----- ------------------------------------------------ Contractor's Name------- �. --------------------------------- -----.----- Phone------------------------- ---- t Installation will serve: Residence 23-l"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-_ Numb re of bedrooms��_ _-___ Number of baths _./'"Cot size -_----__-._____________________ Water Supply: Public system 2--Community system ❑ Private ❑ Depth to Water Table i(f,"aht. Character of soil to a depth of 3 fee- -Sand ❑ Gravel p Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe g]---Nardpan ❑ Previous Application Made: (If yes,date-------------------I No � New Construction: Yes ❑ No [BB 'FHA/VA: Yes ❑ No 9�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted'if public sewer is availa'61e,within 200 feet.) 7 Septic Tank: Distance from nearest wel'i - Distance from foursdation----------------�,_Material------__--_.___.__._________.________._________- "y/5J/o>� No. of compartments --- ----- ---- :.Xiquid depfh--------------------------Capacity---------------------- - ----------- Number -- Disposal Fiel Distance from n ares well-_-___-----_--_bistance.,.ffom foundation:_--/.,�---__-_.Distance to nearest lot Gne____ ___________ Number of lines � ` _ _Len th.,of each line___ -= ---- � Width of trenc��,- ---------------------- Type ---------- --- ---• Lam^ -- - -------�---- ------ 9 --- - � -- Type of filter material____Depth of filter material--A ��________Total length____l. ------------------------------- Seepage ___________________--_/____. Seepage Pit: Distance to nearest w'ell------—----------Distance fr fou dation___- ---_-_Distance to nearest lot line..4----------- *V ❑� Number of pits._.._/ -----------Lining .material__- Size: Diameter__, .-_-{-_Depth_ ---___._.___-_____..__ 1� Cesspool: Distance from nearest well_`--_'',_____Distance from foundation--------------------Lining material______________________________________ _p ❑ Size: Diameter----------------------- �,�---.Depth----------------------------------- q Capacity---.________________Li uid Ca acit gals. Privy: Distancefrom nearest well-------_-----_-----------------------------------Distance from nearest building' ------------------------------ ...__-_.. b ❑. Distance to nearest lot line------------------------------- -- =------ -------------------------==--------------------- ------------------------- ------ ----------- Remodeling and/or repairing (describe):-------------- --------------------------------------------------------------------------- -----------------------•------------------------------------------------------------------------------------------------------------ ------------------ --- '------ --------------------------- ------------------------- -----------------------------------------------------------------------------...--------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 of :the San,Joaquin Local Health District. �Si neda.(� 9 ]--------------------- � ----�-- -- -- �--- ------------------�------------- -- ------------------..-----------------------( dor Contractor) - --------------------- (Plot - -- ------------ [Ti#le) �1�� t------------------------------------ By:_ (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- .--•---�� - --------- ------------------------------------DATE------7- --I--=- �-q--------------------------------- ,, REVIEWEDBY------ ------------------------- ------------------- --------- - --=----------- ------ ------------•-------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------•-----------_ -- ------ ------------- ----------------- ---_-----,------------ ------ DATE---------------------- --------------------------------- Alterations and/or recommendations:._.__ 1_,.7_��.. E:...____.1.v�_S{��, �A___-_____.__ ..Q -_ ------------- ------------------------------------ - ---------- i - -------� t ------ ' - -----------------------Q-1--� --------- -----•------------------- --------------------------- ------- -------- ------------------ --------- ------------------- -- --- ---•---------- ------------------------------......------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:- _�...� - ------------- Date--- d ' £. SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxellon Ave. 300 West Oak Street ,t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Tracy,California ES 9 REVISED 8-59 31A 3-'63 F.P.CD. 15