17078 - Laserfiche WebLink

Home Browse Search

F -- OFFICE USE; -------------- it No- -----L7 Perm W.79 APPLICATION FOR SANITATION PERMIT ----------------------- --------------------------------- -3 ---------------------------------------- -- ------------ (Complete in Duplicate) // Z�� V Date'Issued --------- ...Z. ------- ------------------- ----------- ----------- This Permit Expires I Year From Date Issued L Application is hereby 'Made to the San Joaquin Local Health District for a permit to construct and installtheherein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_____,"_S =`------------t-'-------1% ----------------- ------------------------------- Phbn'e_*ZX25��_ Owner's Name--------02 -------- �_ c i1a, $-------------------------- Address--------------------------------------(.4--aL----�_ ------------------------------------------------------------- -------------------------------------------------------------------------- Contractor's Name----------- --------- --------------------------------------------•-------------•---- Phone---f,�6-�3�_07 Y 'I Installation will serve: Residence Apartment House [] Commercial [] Trailer Court [] Motel C] -Other El .Number of living units: ___I___ Number.of bedrooms -,?-- Number of baths _J----- Lot size ...-__.IS___--____ ----------------------- Water Supply: Public system Community system El Private F1 Depth to Water Table 6-0- ff. Character of soil to a depth of 3 feet: Sand E] Gravel F 'Sandy Loam EClay Loam [ Clay [ Adobe ' 0 Previous Application Made: (If yes,date................._.1 No New Construction; Yes E] . No FHA/VA: Yes D NoX TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------ ------------------------------ F1 No. of compartmearifs------------- ------------Size----------I----------------------Liquid clepth-------------------------.Capacity----------------------- D;sposal Field: Distance from nearest well-----------------Distah r ce from foundation---................Distance to nearest lot line_________________ _ ." ` F1 Number of lines-------------------------------=Length each line-----------------I------------Width of trench----------------------------------- of 'be-fh"of filter material----•------------------Total------------------Total length------------------------------------------ Type of..filter �naferial------------------------ p %P Seepage Pit: Distance to nearest Distance from fXSize: ation---Ile)-'__Distance to nearest lot line---s,�-------- 0 �_10 NA Number of pits......./------------Lining;material_A 04-x= Diameter-__-.Z,.'_I 4Depth_._._...___ -------------- 5pt- i-- 'rest well jr -----:---------------- Cesspool- Distance fi,orn nearest --------------��_Disfance from foundation----_.__:_____.__..Lining-------- ---Lining material---- --------- 7 r Depth------------------------------ ----------f----------Liquid Capacity- ------------------ F1_ Siie: Diameter---------------- -------------r------4� ---------gals. Privy: Distance from nearest well----- ---------`--------------------------------Distance from nearest bu.i4ding----------------------------------------- El Distance to 'nearest lot line_--------------------__. 4-------------------------------------------------------------------------- ar Remodeling and/or repairing (describe):---____ ---e!71P_Xe �_ --------------------------- w Q1 ----------- ------------------------------------------------------------------------- ------------- --------------------------------------------:------------ ---------------------------------------------------------- -- - ---------------------------I--------------------------I-------m-------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------I---------------------------------- -------------------------------------------------------------------------------- ...... I hereby certify that I have prepared this application and that the workwillbe done in accordance with San Joaquin County ordinances,-State laws, and rules and 'regulations of the San Joaquin Local District. (Signed)----------- ......!_ --- ----�- ----------- -------------------------------- ----------------------------- -------(Ow er and/or Contractor) F . . -%a BY-------------------- ------------------- ----(Title)---------- ---------------------------- - --------------------------------- 4 location'(Plot plan, showing,size of.lot, lo�,,�Aioin��sys ��n"in relation to wells, buildings, etc., can be-placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... --- DATE------- ----------------------- -- -- ------ ----------------------------- # - -- ------------- ---------------- REVIEWEDBY------------------------------- ------------------------------------ ------------------------------ -------------------------- DATE----------------------------------__---------:--------- -1 DATE__..---------------------------------------:--------------- BUILDING PERMIT ISSUED----------I------- -------------------- ------------x---------------------- Alteration, and or recommendations:--.____-- --------------- ns:--. ------- - --------- --- ---------------------------- --------- ---- -------- -- ---------------- ------------ -----------12�. ------------- ------------------- CA-, ----------------------- ----------------- ------------------------ ------------------------------------------------------- --------------------------------------------------------------------------- --------------------------- ----------------- ----------------- --------------------------------------------- - ----- --------------------------------- --------------------------------------------------------- . ... . ...... --- -- --------------------- FINAL INSPECTION BY:_70_1... --------_---------------------- Da - ------- . - . . 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'63 F.F,C9.