16354 - Laserfiche WebLink

Home Browse Search

FOR FFI E USE: ------------------------- ----------- �_- APPLICATION FOR -� ' ------- --------- --- ------------------ OR °SANITATION PERMIT Permit No. .../�..17... ------------------------------------------ --------------- - - (Complete in Duplicate) q / _______________ ___________________________..__._.-__. Data Issued This Permit Expires 1 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 CountyOrdinanceNo. 549. JOB ADDRESS A p LOCATION_./ 9__�Sl �%� 1 Owner's Name-- ----------------------------------------------------- --------- - ---- ----- --------------------------------- Phone---=--------------------------------- Contractor's Name---- - ?-- -------------- -••--------------------•---------------------------------------------------------------------- Phone.---•-------•---- f Insttallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ Z__ Number of baths __'___ Lot size �$'�---..Z.ZcJ ___-- Number of bedrooms _ -------•---------------------------- Water Supply: Public system ❑ Community system El Private ter Private ® epth to Wa 'Table Aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe (Hardpan ❑ Previous Application Made: (If yes,Idate--------------------I No gR`_ New Construction: Yes 091"No ❑ FHA/VA: Yes ❑ No m TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r__ Septic/Tank: Distance from nearest welL%5_0__--_Distance from foundation___________________Material ____-._._-____ ~____o__r_r_s_ -.___----------------- Liles No. of compartments__ -2------------------Size....3..)I-------Liquid depth--�_--_-..-------------Capacity---'AIN' -4 Disposal Field.- Distance from nearest well__------Distance from foundation. 0..r__.-.____.Distance to nearest lot line-_(_1 ---- Number of lines-------I-------------------------Length of each line__9&. -----F-----------Width of trenches_ _�-_________.__._______-_- ,J QG:E__-___--Depth of.filter material___/'_____________Total length____94__i____________-____-________ Type-of filter material___ 9 b r f s Seepage .it: Distance to nearest well_-/A _____________Distance��jjom f undation-_0-_____-______.Distance to nearest lot lin�e_�-________ l� Number of pits... -Li material___!t .__-.Size: Diameter-__3- --------------Depth___Z '_ _________.____. C Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- Q ❑ Size: Diameter--- ----------------------------------Depth--------------------------------- -----------------Liquid Capacity--.------------------------gals. �. Priv Distance from.nearest well................. --------------Distance from nearest building _---------. 3 ❑ Distance to nearest lot line---------------------------------------------------------------•----•--•-------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------•---•-------------------•----••--------------- •-------------------------------•- i --------------------------------------•-----------•-----------•------•---------•-------•------------------------------_------------'----------------------------------------------------------------------------------------- --------------------------------------------------------------- i -----------------------------------------------------------••-----------------------------------------------------------------------------------------------------------------•-------------------------------- 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 e n Joa uin Local Health District. , f Ownerand/or(Signed)-------------------------------------------------------------------- -------- - --- ---------------------------------------------- ------------------{ / Contractor) By: ---------- - ------- ---------------------(Title)--------------------------------- (Plot plan, showing size of lot, location o syst in relation o wells, buildings,.etc., can be placed on reverse side). : FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------Z__ o_ -- -- ------------------------ ----- DATE...... ��._ REVIEWEDBY----- -----------------•------- •-- ------------------------t--- •---------------------------- DATE------- ' J BUILDING PERMIT ISSUED --i------------------------------------------------------------------------------------- DATE_.----------------------- ------------ Alterations and/or recommendations------------------ - --------- ------------------------------------t--------------------------------------------------------- ------------------------------- ---------------- ----- ---- ----- --- - - t•�--�� ---------------------------------------------------------- ---- ----------- ------ ----- ----- -------------------------- ----- ---------------------------------------------------------------------------------- -- - FINAL INSPECTION BY:----- --------- ---------- '� Date.------ `` 7-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 31A 3-'63 F.P.CC.