17624 - Laserfiche WebLink

Home Browse Search

F0Rir0FFlQ' USE, ------------------- ----------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. ../.7._ ------------------- ------------------- ,A,(Complete in Duplicate) ------------------- ---------------------------- I x , Date Issued ...... --- ------------------------- This Permit �Xi:tir-es; I i- fair'Nom Date Issued Application is hereby made to the San Joaquin Local Health bi'0'riJ for'-a permit to construct and i stall the work herein described. This application is made in com pl ia nce with,County Ordinance No. 549: e Jkl�ADDRESS AND LOCATION------------------ ------- ------- --------------------------------- � ------- ---------- Owner's Ncme-tC - Phone- J/------------------------ ------ - Address--- - -- - --------- ------- --------------- ----------------------------------------------------------------------------------------- - -------------- Contractor's Name-----C—IJ-46-0 ------------ ----------------------------------------------------_ Phone----------------------------------- Installation will serve: Residence .[Apartment Ho_U';'S'e El Commercial E] Trailer Court Ej Motel'E] Other E] 1, ---- ---------- ---- Number of living units:�--- Number of bedrooms of baths Number _yam-..Lot //'7 -1-- -- -- Water Supply: Public'syster;M[] Community tystern E] Private 2!1'�Depth to Water Table ft. Character of soil to a depth of 3 feet:—Sand gj"-Gravel-0•--Sandy-Loam Q Clay Loam [] Clay E] Adobe F] Hardpan E] Previous Application Made: (If yes,-_0ot1e_�-&`- 0_PT`-r4Z_1W Construction: Yes Ej-`6o ❑El. FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS:. —�—r res- -• —,4- Tcte= ;iiavai4 �ii -; septictank or cesspool evadable Septic Ta k: Distance from nearest well--` Distance from foundation la-------------Material---------------- -------- en' :�Y_- -ko. No. of compart�n ts-.'l---------------------:Size--- -------Liquid clep�h---4------ ------------:Ce ta'; y__/ Disposal Field! Distance from nbareqt weIi_-_,:5...0..._,,Distance from f8undafionJA__r__.......Disfance to nearest lot line<:57 0------------- -- - - ---- Number of lines--, ------------- -------------Length of ea ch line---7 --- Width of trench. 940 Type of filter�..maferiaf_.T&<,�--_-___._Depth of.,filter material-/.r.- Total length--:- --------- ----- f Seepage P• Distance to nearest well------5Z2---:---Distance from foundation------/ --'.--.Distance to nearest lot P Number of its-_- material 8047 .-_ Size: Diameter-- -X__-57Depth---. ------------------- Cesspool: Distance ,from nearest"weil----------------Distance from f6unclation------------------ Lining material------------------------------------- El Size:-,Diameter-----I---------------------------- -� - - Depfh----------------------------- ---------------------Liquid Capacify----------------------------gals.L --- Privy: Distance from nearest well---------------------------------------------- Distance from nearest building___..___._________.____.___ --- -------- ❑ Distance' to nearestlot line---r------------------------------------------------------------------- ------------------------------------------------------------------ Remodeling and/or repairirig Idescribe):----------- . ......... ---------6"_OR _9:------------------------ 5F ---------- ------ - - --- --------- _1�b------- - ---------- D---------01.=.......44.1V-------- ----------A_7A_K a-------op--------- --------e-de—------------ ---------------------------------------------- ----------- -1------------- ------------------------------------------------------- ------------------------------ -------------------------------------------------------------------.----------------------------- ------- I hereby certify that I have prepared this application and that the work will be dofie1n accordance with San Joaquin County 1,k) ordinances, State lalsyand jrull and regulations of the San Joaquin Local Health District. ... .. ... (Signed)------- --- ---- ----------------------------------------------------(ewter-a"4601 Contractor) --------- --- ---- - ---- ------------------------------(Title)-------------------------------- ------- - ----------------- ------- - --- --------------------- ----- --------- '4s,_et� ---------------V:- ow'ing size o o buildings, etc., g-cfdtFNeveFs4 sidle " on (Plot plan, showing oc i-bn,.-,of, system in relation we C., can FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY;;`' -m-------------------- ------------------------------------ --- DATE-- X ---------------- REVIEWED BY - - ---w- DATE_ . --- BUILDINGPERMIT ISSUED--_'--:- ------------------ ------------------------- - ---- ------ -------------------------------DATE-------------------------------------------------------------- Alterationsand/or recommendaf ions:------ ------------------------------- ----------- ------------------------------------------------------------------------------------------;----------------- ---------------------- --------------------------------------I----------------- -------------------------- ---------------�7_7--------- ----------------------------------------------------------------------------------------- -----------------------------------------------------I------_%�.;----------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ------ ---- --------------------------------------------------__-------a-------------------------------------------------------- ------------------------- ----- ----- ------------------------------------y --- ---------- ------- - -- ----- -------- ---- ---- -- -------------------- -- ---------------------------- ----------------- ---------------------------------I-------- FINAL INSPECTI - - -- -- ---------------- Date.--------7 ---------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9#h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 33-59 ;$M 3-'63 F.P.CD.