17719 - Laserfiche WebLink

Home Browse Search

�O�OFFICE USE: �� r Y_6 --- _ APPLICATION FOR SANITATION PERMIT Permit No. _._!..•7747; ---------- ------------------- ---- _ _ . .(Completa In Duplicate) y p } Yw.......- — Date Issued ----7--��----�1 _ "" ---------- Application --_-.- - i 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 instal4 the work herein described. , This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN C TION ______.__ ""-- -- --- - -- ------- .vim -- - . -__ ,1�d --------- ----------- --- ----- Owner's --- Phone. Owner s Name-------- �- • • � -------- Address------------------------- ~- � --------- ---------------------- Phone----------------------------------- Contractor's Name---------------•-- - -- -"- � Installation will serve: Residence ❑�partment House ❑ Commercial ❑ Trailer-:C ourt ❑ Motel ❑ Other ❑ ) Number of baths -- - Lot size __ '1 Number of living units: --f" mbar ofbedroo7 .0ms :. :; Water Supply: Public system "Communi s stem Private El De th_to Water Table -------- ft. y Adobe ardpan ❑ Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay L1 am ❑ Cla [] No Previous Application Made: (If yes date__.._..__-- ) No LX New Construction: Yes `lo ❑ FHA/VA: Yes ElI �. TYPE OF INSTALLATION AND,,SPECIFICATIONS: 1 ` t, -N No septic tank or cesspool,,permitted-if public sewer is available within 240fere/t .�,- ®/ _Material____ Septic nk: Distance from well__._��_ Distance from foundation-- _____i____:_. T rtt ' __ 1 -------- --Ca Capacity- -------- of tom artme*ns_e_- Sry Lid dth No. %. l I Disposal ield: Distance from nearest well__:--------------- from foundation__J/ "�_:"-.Distance to nearest lot line____ th of Number of lines----- r�- �IDe gh off.f Iteh mlaterial { `-----Total hlength tire, Number ------ ------- pQ t Type of filter. materialCJ ---- P Seepage iT: Distance to nearest,we115:..-�r�"�---- Distance from foundation�d-__.__.Distance to nearest lot lire -"______._ - -9---- Depth -_ -_r Number of,pits----- material__ --=-- Size: Diameter. , r --- 'Cesspool:Cesspool: Distance from nearest`weVl_____ ___.__Distance from foundation_- _._ ___ Lining material_ ______ ___ ______ -------------- Size: Diameters _ iI-Depth--------- --=--:--------- :-- ---- ------- - Liquid Capacity -gals ❑ t r. - ----------------"--Distance.from nearest building--------------------•--------------------- Privy: ------------- -._. t Privy: Distance from nearest well'__._.-____________________ 7 ❑ � - ------------------------------ ------------ - ---- Distance to nearest lot line:_____________-_._--____ -- -- ._ -------------•----- t - Remodeling and/or repairing (describe)-------------- -� -- -- -------` _l-------•--•-------------•----------------------------------------- / ------- --- •----"--------------------------------------- ---•--- - ------ ---•--------------"--------------'-------------- _ 1 i } I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County < ordinances, State laws, le and re tions f the San Joaquin Local Health.District ------- {Owner and/o ontr tor` Si ned BY:---------------------- --------------- 1?� . -----------------------------------(Ttt+ 1 - (Plot plan, showing size of lot canon-of-system-in-relation-to-wells,,buildings,-.etc.,.ean,be placed on reverse side). _ f FOR DEPARTMENT USE ONLY 6 - ------------------------------- DATE_..7� ? ------"---- ------------- ! APPLICATION ACCEPTED BY____________ ___ _ --- - ------------------- REVIEWED BY------ •------------------ --------------------- ---•------------------------- ---------- --------- DA _ - DATE------------------------------=-= BUILDING PERMIT ISSUED------- --------------------•----------- ------- -------- - Alterations and/or re omme ations: _.____._------�-i-------------- - ------------------ """" C --------------- ------------- ___________________________ -- ---------- - ----------- _ ^�z. ------------- --------- ., Date...----- ------------ �- - FINAL INSPECTION BY:.----------------�-�-- ------ I . i y f SAN JOAQUIN LOCAL HEALTH DISTRICT � `° '124 sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. ; 300 West Oak Street \y ` Y i > ,'I, �. Manteca,California Tracy,California Stockton,CaliforrL\ .lodl,California '� E$ 9 RF:vlsFp B-59 3M 3-'63 F.P.CO. v