14934 - Laserfiche WebLink

Home Browse Search

- FOR OFFICE USE: ,.tom -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___r�_X_�. ------------------------------------------------------ (Complete in Duplicate) /49 , � ' Date Issued .............7� .6 Z -------------------------------------___-_____-____ --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a perm to construct and install the esc I e This application is made in camp]iancee'with �County Ordinance No. 549. �jp -4�� JOB ADDRESSf� LOCATION----� ._Qr -- -Q-/j- ---- / --r-----.LY� T.L-_0 _;�`rt:' ._.�!t - -- Owner's Name.. - [a[? •�r----��ri --------------------------------- --- ----•--------- Phone------------------------•----------- _ ' lar"ff .Address---------------_-----_-- --- `` '` ii ' ' '^ 6ontractor's Name"V _�. 2- ...- ........ ..... _-1 .. .._................ Installation will serve: Residence 0�partmen+ House ❑ Commercial ❑ Trailer.,Court Motel ❑`Other'❑ Number of living units: ... _. Number of bedrooms _Number of baths __ -. Lo+Size iF _______ ____-� _7 ___________________ , Water Supply: Public system ❑ Community syste ❑ Privateepth 'to We;Ta13)e ________ ft. i Character of soil to a depth of 3 feet: Sand Gr Sandy Loa ay Loam ❑ Clay ❑ Adob Hardpan x Previous Application Made: (If'yes,date---------------_-_- New-Co uction: Ye3s El No FHA/VA: Yes E] No El TYPE OF INSTAL_LATiON`AND-SPECIFICATIONS ' (No septic tank or cesspool-permitted if pu� ' sewer is available wit in Seti Tank: Distance from nearest well:JM------Distance fPm foundation:_/!Q...........Material _._ No. of compartments___:�i-------s_____�Size_- : ____� ____ALiquid depth__-...� ---------._-_--___Capacity.. '.... ._. P ,+ , — � Disposal Field: Distance .from nearest well_c� _�._Disfa rqo -fou ti n- �� "` ' _ Tr m- ..��'15�...- .--DGsfance to nearest lot line•_-____-�.�- Number of lines_..:: _. ---- a } ` Leri th 'o��e` Tine- _ ____le"{__.W'idth of trench._ ________________'t 9 XType of filter material._ __:_Depth of filter material— ----_.T tel leng+h-------_____�L- k 4 _ �, z,. Seepage Pit: �.Distance"to-nearest well--___----f ____Distance from foundation____________________Distance to nearest lot line------ El t ❑ Number of�p -----------------------Linings material--- _---.$ize: Diameter------------ ---------Depth..................----------------- Cesspool: ..�'-:-- F, Cesspool: Distance from nearest well------- from foundation--------------------Lining material___-____---___-____________i__._._._ ❑Y , ,,. 1 Liquid Capacity els--. F---------------------`--------..Depth----•------------------- --------- ----- 4 P ty------•-------•----....___g r Priv Distance from nearest 1 rest well_________________________________________________Distance from nearest buildin ❑ Distance to nearest lot line---------------------------------------------------- 1 Remodeling and/or repairing (describe):- ' -- - --- ------------- -•---V_� -----! ---- .�. ----------------------------------------------------------------------- ---- + - --•---- ---------. w ------------------sem----•------•---•----• ----•-•----...------------- --' -- __f - ----- ---- r--- ------ I-- I hereby ce hat I have prepared this application and that the work will 60 done in accordance with San Joaquin.County ordinan s, n rules and'tegul tions of Vean, Local Health District. (Signed)--- --- ----- ------- _ = --------------------------------- --By:............... -•--•--------•---------------—_a ....--- •-- ..........=-= •-=------------------------ -- --- -- Title----- --------- - - (plot.plan, showing size_-of,lot,-location of,'ystem in relation to wa -U'Idings, etc. can be_placed on reverse side]. .4 �. s FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY---- --•--------------------------------------------------� - - l-C DATE---------- REVIEWEDBY........................ I---------------------------------------------- ........................ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED ,� � T 1.i1! j'------ ........'T./.�_e.--. DATE------------------------------------------------------------- Alterations and/or recommendations:__'_,__..------ ------------------------.-.------------------------------------------------------------------------------------•-------------------------.s.. --------------------------------------• E-F-------- 477HRA.-!eas-----r-------------------------------------..-------------------------------•-- ---------------------------`; •- } ...................................................... ._ _;I-•-------------- --- ------------------------------------ --- --- -------- ._ FINAL INSPECTION BY: - - ---- f��. �'" Date-------- 1 � + SAN JOAQUIN LOCAL HEALTH DISTRICT \ {} 130 South American Street 300 Weft Oak Street 124 Sycamore Street 205 West 9th Strast Stockton,California Lodi,California Manteca,California Tracy,California EB 9'REVISED 0-59 2M 9-61 ArLAD t 4'1