16724 - Laserfiche WebLink

Home Browse Search

I-UK UFFICE USE- ---------- SE ------ ---- ----------------- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No, ------------- •---------------- ------------------------- (Complefe in Duplicate) --- -------- - ---------------- ----- ------ ---- This Permit Expires 1 Year From Date Issued Date Issued _!� yv A-3 22(o—ti o rt 7 Application is hereby made fo fhe 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-. -01� IF�,� ��rr JOB ADDRESS AND LOCATION-1�(-__ ! _--- . _�1J�--- Owner's Name_ L lEr P � C� �T_'�-------=---------�._--�_- _K---------- hone. Address �' 175----- ----- r,- 'I Ft Contractor's Name------t R �}% :� = -------------- w _ ------------------------------------------------ ' Installation will serve: Residence [ Aparfinenf House 0 Commercial El Trailer Court ❑ Motel ❑ Other ❑ Number of living unift _-� Number of.bedrooms ___3:MNuri&r of baths Z Lot size -___ _. A '-------------- Water Supply: Public system❑ Community system ❑ Private eDepth to Water Table � _ ft./2= Character of soil to a depth of-.3 feet: Sand ❑ Gravel'0 Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe ❑ Hard an ❑ Previous Application Made: (If yes,date................ ' ) No New Construction: Yes eNo ❑ FHA/VA; Yes�No ❑ ' -4�TYPE:rOF-INSTALLATION-AND-SPECIFICATIONS:, j ` ".(No septic tank or cesspool�,ermitted if public sewer is available within 240 feet.) p 3.`�r1 _Distance from foundation______. 4 4 !Z "p Septic T nk: it Distance from nearest well--___. �Q_ Material ��-� .�R F ,r compartmen{ts------ -_ Size_ I -� _Liquid d pth__.��,� -_ - p Y p Distance from nearest welL_ �-_: Ca out Jvo___ 'Y No, of; Dis osal Field: " Distan f "'' -f-�" =1 �`"` Distance from foundation__,�Q- _ _ Distance to nearest lot line____ Number of lines---y-_11--- ---- Length of_'each".line--____-- �I {I'lE r -----.Width of trench----3�: _.. Tipe,of filter material-__ C --_Depth of filter material____ 1, -___------Total length-------6j _-!__________________ �. Seepage,Pit: Drstance to nearest well----75°+t_____Distance from foundation ______.Distance to nearest lot line_- ___._ �` Number of p,+s._..V _______________Lining material__ (,? Size: Diameter_ . a / }� f C X. Depth -----------=---------- Cesspool: Dsfaance from. nearest well-________________Distance from foundation__--_.-----t.------Lining material__.___-_.__._______.__-_-__..-_____•• ❑ Size::Diameter____. 1 i --------Depth------- ---- - ------ --- - ---------Liquid Capacity ----- - ----gals. r ' s ❑ Distance fo,.nearest lot line-___-___ Distance�from,nearest building_____________________________ Priv Distance from nearest•well__._______ _________________ �. -------------- ------------•-•-------------------- F Remodeling and/or repairmg (describe):_____ ---------------------- ------------- ----- t41DA f...= -:-- I + - --Jfl hl �--------------------- ----- ------------------ --------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- i' I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St f laws, and rules and regulations of the San Joaquin Local Health District. It ... (Signed o } �O f -_- ----- _ Owner and/or Contractor b EBI y. - ----- ------ -------- ------ ------(Title)---- ----- � •- - (Plot plan, showrng� 40-of-lot,location of system tri relafion to wells, buildings, etc_can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- R,--0 ----------------------------------------------------------- DATE------- - - ------------ REVIIWED BY ------ -------- ---- ----------- ----------------------------- DATE r BUILDING,PERM iT-ISSUED— ___ _. :YT_ =_-_--=--_ . ------------------------------------- -- aerations and/or recommendafionst -- -------------- - -------------- ,------------•---------------------------•-------------------•------- - •--------------------------------------------- - - ------------ `�-'�------�--- -�` -% t ------------------------------------------------ --- _ w --------------- -------•--------- —ri' ` ^ = I -------- -- FINAL INSPECT] " �- : - -- ------- Date_ . 24_.`-- a-__'------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT f� 1601 E.Hazelton Ave. 300 West Oak Street T24 Sycamore Street 205 West 9th Street Stockton,California :',Lodi,California Manteca,California Tracy, California E5 9 REVISED 6-59 3m 3-•63 f.P.gp. " - N