17243 - Laserfiche WebLink

Home Browse Search

OR OFFICE USE: „ s _------ !1. _ Permit No. � PERMIT . _._.._ _ APPLICATION FOR SANITATION - ��•= �'�- /orf, (Complete in 4�uplicate) Date Issued ------- -- - ------------------------------------- --- This Permit Expires t Year From Date issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and in the work herein described. with County Ordinan No. 549. This application Is made in compliance pP � - -- JOB ADDRESS AND LO ATION_-':�_�_/ ----- -- -�---- ,�ff� r�/ y ---------- P --------------- Owner's -------------- Owner s Name--------- -- ----- --------------------- � Address---------•---•---------- .��------.. t Phone._.. 1/ ---/- Contractor's Name. "------ Installation will serve: Residence Apartment Ho se ❑ .Commercial ❑ Trai er Court ❑ Motel ❑ Other E]. ' Number of living units: ---I__ Number of bedrooms --7---Number of baths ---- size ------- - Water Supply: Public system ommunity system ❑ Private.❑ Depth to Water Table _��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ Previous Application Made: (If yes date_"_______ _______) No F1 New Construction: Yes ❑ FHA/VA: Yes El No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' k (No septic tank or cesspool permitted if publicjseer is available within 200 feet.)` - --------- Septic Tank: Distance from nearest well-0- istance from fo tion__ -------__.M iplt ,�` -1/ -Size- J� --Liquid depth �-------------CapacitY v No. of compartments___ __ __________ __ ` ,�� + 1 Distance to nearest lot line___ ____. � Dispos l Field: Distance from-Weare # well_�+�1}istance from foundation__l�.-___..__ �i Number of lines________ _ ______________ _ ___Length of each line------------- _�_�----.Width of trench._ ----=---�--- I Dth of filter material_�/� ---------Total length_______________"--- Type of filter material�e�YD'isttance Seepage Pit: Distance to nearest well_ 0-K from foundation,____ llGl.._____.Dista ce to nearest lot iine�sa. ------ Lining material_ . -------- Size: Diameter. �q _.___Depth_.Z y_- - -------- -- Number of pifs----�-----=-- - --- - j Cesspool: Distance from,inearest-well_________________•Distance fro. foundation----------------- material Diameter------- -----------------------------Depth--- ,----------------------------------------------Liquid Capacity-'--------------- gals. ❑ t- - -----------'Distance:from nearest building--- ----------------------------------- Privy: Distance from.nearest well_______.___--------------------- r ❑ Q Distance to nearest lot line._------------------------------------------------------------------------------------------------------------------- El --------------------- - Remodeling and/or repairing (describe)__________ _____ � --------------- ------Z:3r� ------------------------------------------- ------------------------------------ -------------------------- -- i I hereby certify that I have prepaied this application and th t the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul tions of a an`Joe in Local Health District. I " -------------(Qwfler df T-Contractor) (Si9ned)Cz5W_AW,4 --- -------(Title------------------------------------------ By: ' ---------------_---- ----------•-------------------------------- g ) (Plot plan, showing size of lot, location of system in relation to wells uildings, et ., can be placed on reverse side}. FOR DEPARTMENT USE ONLY /L DA `T� ----------------- APPLICATION ACCEPTED BY-------Al. --------•-- - - -------------- ' TE r REVIEWED BY----------------- ----------------------------------------------------------------------------------------------------------- ---------------------------------------------------- -------'----------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------- •- ------------- DATE------------------------------------------------------------- ----------- --------------------------------- -- f _:C_R------ Zy ' Alterations and/or recQmmendations:-_____` - ---f---""--- --- �- "- T �"J� ~ �'� rr- r - -------•--------------------------- -- ---------. - -- ------------ - - ---------------- FINAL INSPECTION BY:_� ---.- �� --` Date---- ---------------------------------- FINAL - - ---------------------- I / fSN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street " t4 Manteca,California Tracy,California Stockton,California Lodi,California _ � E5 9 REVISED B-59 3M 3-'63 F.P.CO.