16467 - Laserfiche WebLink

Home Browse Search

FOR OFFICE _�JSE: --- --------------- c-- --�a- .- --_. ,_ - 3G�------------------- APPLICATION FOR SANITATION PERMIT Permit No. .'3lJ-----.- - - �.�� ---------- �. (Complete in Duplicate) (-. /•-� ----------------------------------------- --- -- - This Permit Expires i Year ---•--_ From Date Issued _ 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 County O finance 11ho. 549. JOS ADDRESS AND __� � �nI C Owner's Name 3 _! .lrP`� -------------------- Phon __- .. ...._ 9 r Address ------------------ ---= J �� -- . � _ --------------------- Contractor's Name :---- ------ Phor!�W_ ..--- -- Installation will serve: Residence 0--A—partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:..-/-_ N b'er of bedrooms _��Number of baths -_f--__ Lot size _ p_ _ .._ _ ______-____ F Water Supply: Public,system Community system ❑ Private ❑ Depth to Water Table loft, l ,Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________} No ❑ New Construction: Yes ❑ No PHA/VA: Yes ❑ No ❑ TYPE F INSTALLATION AND SPECIFICATIONS: f 3 is se t'C-tank or cesspool permitted if public sewer is available within 200 feet.} 1- F S pt' nk: Distance from nearest well-----------------Distance from foundation--------------------Material___-------____.---_____-_________-_----_-.____. r - r :No. of compartments--------------------------Size--------------------------------Liquid depth------------- ----------Capacity---------------crr------- D' osa ie#d Distance from near well. It t -Distance fromafaundation__ f___-___Distance to nearest line____ ---____ Numbe�,;of lines_--. `___.__ ______Length of each line___ �- -- - ---------Width of trench____ �f Type of'fiiter'materia3 , . ___Depth of filter material-------- 7--------_,-Total length------------------------- Seepage P : Distance,to nearest well ------Distance from foundation-----_______________Distance to nearest lot line-------% 4 Numberof pits-.--- ----- material--:---4 '_ --.Size: Diameter---. .--------.Depth......�,e- ------------- r Cesspools',,=*t.~." ' Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------.__________._. �O.t 'Size: Diameter------ ------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. i Privy: Distance from nearest well_---------------------------------------------__Distance from nearest building-----------------------------------------' - � Distance to near,st.lot line- ------------------------------- - ----------------------- --------------------- ----=------------------------------------- ---- Remodeling and/or;repairing {desc`. ------------------ --------------------------- •--- ---------- =" ----------------------------------- ------------------------------------------ ----------------- - -- ---- ------ ----------------------- -------------------- -------------------- -- --- ------•-----•--------------------- - -- --•-------•--•--•------------------- ------•--- --------------------------.-...-_ l I hereby certify that I have prepared this application and that the work 1 bVe accordance with San Joaquin County ordinances, 5f ew�l, �t�d rule and regulations o e San Joaquin Lo al Healt F N. I /�/I' 1 IE (Signe( ' � ---- ------ -(Ow-01 �.or.Contractor) -- --- --- By:--------- Xbo (Title}---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relatioells, buildings, tC., can be placed on reverse side). I # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY l s � �-'-----=------'----------------------------------------------- DATE---- REVIEWEDBY------------------------------------ --------------------------------------------------------------------------------.... DATE-------- ----------- --------------------------------------- BUILDINGPERMIT ISSUED__--------- ----------------------------------------------–--------------------------•----------- DATE------------------------------------------------------------- Alterations and/or recommendations,_ -- - ------------------------------------------- -- .. ------------------- �� - a"+' ,/Jx ------------- --------------------------------•---------- ----------------------------------------------=------------ `--------- ii F' FINAL INSPECTION BY:---------- - ------ --------------------- M Date--- - -- - ----- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Notelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 4 REVISED 6-S9 3M 3-'63 F.P.CD.