16457 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --- -------------- 7 ..... . --------- ------- ----- -- (Complete in Duplicate) o Fr ,� .2.�• Date Issued ........:.. ....�a_ From Date Issued Application is hereby made to the San Joaquin Local Health District for r `�- This Permit Expires 1 Year pp y 9 a permit to construct and install the work herein described. This application i ade in compliance with County Ordinance No. 549. F&cAL_o�x - �- JOB ADDRESS A LO ATION - EW/R� Y b. ---- -t�k------OF-_ W_/X-----/ ---------------...... Owner's Name----------` `- 1� ---- -------------- Phone-----.------------------------------ Address------------------ _---•------ =Address------------------ Con'tractor's Name�a�1Q�}�:-.. �!_P�A-4QA[C—RE—r T-1-JEE7'------- ---- ---------------- -------------------- Phone----------------------------------- Installation will serve: Residence ( ' Apartment House ❑ Commercials ❑+ Trailer Court ❑ V_�f Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms 3_.��Number�of baths __/___ Lot�size •__ ___._A—C—A-"._____ Wafer Supply: Public system Community system Private /De th to Water Table . PPY Y ❑ Y Y t ❑ E p t Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan 1 � Previous Application Made: (If yes,date________________1_1 No New Construction: Yes J21/IJo ❑ FHA/VA: Yes ❑ No - TYPE OF INSTALLATION AND SPECIFICATIONS:' - - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic nk: Distance from nearest well_.J�-Q____-Dista e from foundation----ta.----------M teiiaL__4CdNCFFr--_.____...� p /� No; �of cam aril ants°..___`_ X r fJ_ �4 ___.Size_ __Li uid de th__..�,/. • p i � - ---- ----- --• -- - - --- --------- q P - ,Z---- ;irk apacltY-��€J�----q •� Disposal Distance from nearest well--5_..._Distance from foundation ___ ...___.'�' p .. ��___._,Distance to nearest lot Number of lines$"""" "" _-_____ _________Length of each line___,�,r_ -__ _ Width of trench-------- _ _ t �i �n 1/q/ Type of filter material----A0_C-}'�--Depth of filter material------I-?_______.Total length_lig__-__-/LfiQ_______�l_`!!___ I'? Seepa Pit: Distance to nearest well fQ. _.____Distance from foundation----1Q---------Distan�e to nearest lot line____% Number of pits-----I.---_---aUning maferial__j?QGK_---Size: Diameter----3-6------ -----Depfh--------M-j--------------- a Cesspool: Distance from nearest well-----_______. Distance from foundation--------------------Lining material______________------------------------ E-1 _ _________________❑ Size: Diameter--------------------------------------Depth�-------------- ----------------------------- -Liquid Capacity----------------------------gals.L Privy: Distance from nearest well - -------- _,•,Distance from nearest building_____________________________ 11 ❑ Distance to nearest lot line----------------------------------- ....-- ------------------------------------------------------------------ --------------------------- Remodeling and/or repairing (describe):____-_ - ----•----------•--------------------------------------------------------------------------------•----------------- �Q'/'��`' Q�L>1 ? "�_Vi1 L.k-11- ---�OM�.. -1L1[�� -----.-DFjAttNftET -== 'r �-I*-- `*%-------'k------------------------------------------------- `T A -A A1110 ------------------------------------------------------------------------•------- -----------------------------------------------------------------------------------'_-------------------------------------------------- I'hereby certify that I have pr� red this.application and that the work will be done in acccrdance,with San Joaquin County ordinances, State laws, and rules a r uletions of the San Joaquin Local Health District. ,^ f s ` `1 (Signed)___I�<lx__ ----- ________________ _.____(Owner and/or Contractor) BY:-=---------- =--- -------------------- -----(Title)---------------- --------------------- ---------- ----------- (Plot plan, showing size of lot,•location of system in rela+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY - ----- ------ ---------- �_ ------------------ DATE--------L_40"-~ --�------------------- s REVIEWEDBY--------------------------------------------------------------------------------------------say -- I r. DATE % BUILDING PERMIT ISSUED _ XTTE7"------171!7_i ..--- ...49'- Alterations and/or recommendations--- ---- ------- ------ :-------------------- ----------------•-------------------------------•------------------------------------------------------------ _____________________________________________________________________________________________________________________________________________________________________ -------P_ ._.__..______________________..__.._-------------,A___s...__ -_ -_ -_.--___.____..___________.____________________._.___-_.._______.__.___.-_____..._.________._-.._______.__.... h ____________________________________ - d.FINAL INSPECTIOLI,BY , -✓�-�-- ;;� I Date _ .. - SAN JOAQUIN LOCAL HEALTH DISTRICT - s 1601 E.Haxellon Av&. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CO. -7