17638 - Laserfiche WebLink

Home Browse Search

FOR10FFICE USE: �r ' ------------------------------------ Permit'No. .--_-_-- _ ---_-,----------_-------------_---------------- -. APPLICATION FOR SANITATION PERMIT / -- -------------=------------------------ ------ ..(Complefe.in Duplicate), - Date Issued __2111--' 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 County Ordinance No. 549. q rr E JOB ADDRESS AN LOC TIO `_ __ _.._-- -- _ -- 4 - ----------------- N4 ' Owner's Name . -- -- + + Phane44--74 > •� A36 � Address.----• ---------------- - -- - ------- -------- ��y Contractor's Name- = ------ - - ------------ = ------ ----------------------- ----------------- Phonej/ Installation will serve: Residence ❑ Apartment House ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- - Number of bedrooms -- __ Number of baths _ Lot size --�j/}- y----13$/---------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table m_ ft. Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ a .Previous Application Made: (if yes,date------------,--------1 No ❑ New Construction: Yes Vf No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well ri_ __-Distan from foundation--- -Q_-._---_.Material _-___ _- , c _ -_------..-..- --- No. of compartments---�--------------:Size yiquid depth---- - - - ---Ca ait -A.d4-C --. ' �� Disposal Field: Distance from nearest well�Distance' from foundaf.i .�Q.-------.Distance to nearest lot line---------------- Number of lines----- -------------------- Length of each lino _, .7_9'247/Vidth of trench-�---e3- -- --- -------- Type of filter mate rial.,.-- €3epth of filter material---/�----------Total length-___._-----_ � I Seepage Pit: Distance to nearest well...------r---.--------Distance from foundation--------------------Distance to nearest lot line----------------- 0 ,Number of pits---------------g_-_-__Lining material----------------4-.---Size: Diameter---------------------- Depth--:------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation---._._._.__---.--.Lining material--------------------------------- ❑ Size: Diameter ,,.'Depth---.--�T---------------------------------------- Liquid Capacity gals. 1 ' --Distance from nearest building . Privy: Distance from nearest well - --------'---------------- ----------- -=--------------'---------- - '--'--'--'-- — I, ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------- ----------------------------------------------- Remodeling ------------------------ ----------------Remodeling and/or repairing (describe}----------------------------------------------- ------------------•-----------------------------•-------------------------------------------•------------ --------- = "= a ------------------------------------------------------------------------------------- ------------------------------ ---------------------------------------------------------------•----------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and ` les and regu tions of a San Joaquin Local Health District. (Signed._ {O er and/or Contractor 01, - - -------- ------ B -------------'------------------= (Title)-:-- - ' ------- -- ------ --- (Plot plan, showing size of lot, location of syst a ation to wells, buildings, etc., can be placed on.reverse side). i FOR DEPARTMENT USE ONLY re APPLICATION ACCEPTED BY------------ 1 < ' ' = ------------------------„---------`, DATE------,-1--"---3& REVIEWED BY----------------------- -- --' - -- -- '----'---'-------------- -- -------------------- --------- I------------------------- DATE---- ----01 ----------------------------------------'----- BUILDINGPERMIT ISSUED----- --------• --------------------------- ------------------—-------------------------------------. DATE---------------------------------------------------------- -- Alterationsand/or recommendations:------------- -- -----------------------------------------------•---------------------------------------------------------------------------------------_ i --------------- ------------------------------------------------------------------- ------------------------------------------------- -- ------------ -------------------------------------------------------------- 3 FINAL INSPEC1ION_ --- Date---------- a£� SAN JOAQUIN LOCAL HEALTH DISTRICT 1' 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stacklon,California Lodi,California Manteca,California ' Tracy,California -rii`9'REVME0 B-59 3M 3-'.3 F.F A.