17301 - Laserfiche WebLink

Home Browse Search

--- eL APPLICATION FOR SANITATION PERMIT Permit No�._ ? ----------- ------ ----------- -------------- (Complete in Duplicate) ' ------------------------- ----7------------------ This Permit Ex ires 1 Year From Date Issued Date Issued ___._ _ ---------494 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 County Ordinance No. 549. JOB ADDRES ATION_. --------�� - �? �. �� 6 �G� Owner's Name --- Vit. --------------••--------------------- %,,a Address---------- --• ---- --- --•-- ----- --------•-------------------------------- -------------------------------- Phone---------------------------•-------- - ' 'n-e, - -------------- ----- J_. ;44 __ c'�'r�� ' Contractor's Name- '' ^ � � _ ' 1 4�1�lp �4 / Phone. Installation will serve: Residence (Apartment House C] Commercial ❑ Trailer Cour} � / ❑ Motel ❑ Others .Number of living units: __'°--f- Nu ber of bedrooms __ Number of baths ___ Lot size ___ ______ Water Supply: Public system Communit system Y Y ❑ Private ❑ Depth to Water Table ___C2 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam ❑ ay ❑ Adobe 2ardpan ❑ Previous Application Made: (It yes,date---------------------) No ❑ New Construction: Yes No ElFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.)Septi T nk: Distance from nearest welf_f_`-_________-____Distance fro foun ' n_/+f f MateriaL_l. --- ------- ----- Ur No. of compartments__��---------------Size_��-��}� , Liquid depth. ___--- Capacity.—/ ;- ? /� �V! Disp sal efd: Distance from near well..._ -/1k/Distance from foundation__/FX_'f_r__.Qistance to nearest lot line.__"--�` Number of fines___._ -- r- ---- - Length of each line_.- ( --- ,r !Width of trg ch--c2 � Type of filter materialG---_--_ Depth of filter material____-/_9'' -- _--Total len tfi__ ___ S , �- Seepa a Pit: Distance to nearest well --Distance from foundation- _ . Distance to nearest lot ----- S" ' Number of pi}s__9rrr______________Lining material-R_o-: Size: Diameter- 4 ar t, Depth_ __"`---------------- Cesspool: Distance f�•om nearest well_________________Dis#ante from foundation--------------. 111 ------ Lining material S+ze: Diameter ------ --------------- ----------Depth_.------- ------------------------------------------Li uid Ca acit Priv � 1q P Y---------- --------- -------gals. ' Y Distance from nearest well---- ----------------------------------------Distance.from nearest building g ------------- ❑ Distance to nearest lot line_.____.____.___-_____.- I Remodeling and/or repairing (describe)------------------------------------------------ ---•----I----•----•----•------------- ----------•-------------------------------------------- a+ ----•---------------------------•-------••-----•------------• --------------------------------------------------- - 3 ---------------------------------------••------------•-----------------------------------------------------------•---------------------•-----------------------------•-------------------- - ------------ I hereby certify that') 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. (Signed) B �i:, .' -------�d/-dr Contractor) l' Y:--------••---------••------------ (Plot pian, showing size of lot, location of system in ation ells, buildin s,-eft., can blele) lace-------------------- ----------------- ------- p d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __--- = DATE _ - - ------------------------ REVIEWED I3Y------------ --------------------- - - -- - -- ---- - f------- ------ ---------- -- --------------------------------------------------------------- DATE.------------------------ BlJILD1NG Pi=RMIT !$SUED----------- ------------ - -------•--------------- Alterations and/orFr•ecommendat�ons:--- 1 l � DATE - ------- ----- _t _. � � �� -----�- -�'`- -•--- -------. _tom- ---------- --------------- ---------------------------------------- --------------------------------------------------------- F _ _________________________________________________________________________________ FINAL fNSPECTlON BY:.. ---- --------- - ---- '- --------------------------------- Date ` ---- -------------------------------------- N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Avs. 3 0 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9.59 3M 3-'63 F.p,CO. � -