17309 - Laserfiche WebLink

Home Browse Search

FOR O` lCEJUSE: - a APPLICATION FOR SANITATION PERMIT Permit No. __--1.- ...71.. ---------------------- ----------- ------------- ---- -- (Complete in Duplicate) ------------------ ------------------ / - Date Issued ----------------------------------- - -------..--.------- 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 install the work here-:n described. This application is made it compliance with ounty Ordinance No. 549. i6ti►' ! b JOB ADDRESS ANDS �LOCATIO �� -A+C:K - .....�..4 — ��:.]-.--.---�_R..----------13.I-Pt.------- Owner's Name V!l t�. Ll.l� - ? 5 -- - ------------------------------------------- ------ - - IPhone. Address----_----------��I--------'-�-�..�� ------------F r.ON------------------------------------------------------------- Contractor's Name---------oa hf k- ---------------------•----------------------------------------------------.----•------------------------•--- Phone----------------------------------- Installation will serve: Residence 5]--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otther E]Number of living units: ------ Number of bedrooms'2_Number of baths ..L_ Lot size ___. ___ ...... MiSf---------------------- Water Supply: Public system ❑ Community system El Private [Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If,yes,date------- ------------) No New Construction: Yes 0--NEo ❑ FHA/VA: Yes ©-�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: T T (No septic tank or cesspool permitted if public-sewer-is-available within 200-feet:}=-i.�_- -� Septic Tank: Distance from net arest well-S-0----Distance from foundation_1_0__�.-______.Mater- I----CONCA�7•�_----_----- No. of compartments___ ___.__._Size._ ..xlaX_ __=___Liquid depth-.-..� ---------Capacify../jl.J_ Q. 1 Disposal Field: Qistance.from nearest well_5-0_-----Distance from'fo{undation._-_./.O. ....Distance to nearest lot line._____.. Number of lines........... Length of each line. '".'I- -.Width of trench.------ ____.-___..._ Type of filter Depth of filter material ..---1e---7.``..... otal length----------4 Z C0..-_-- Seepage Pit: Distance toynearest well......................Distance from foundation--------------------Distance to nearest lot line___________-_._-_ _ ❑ Number of pits----------------------Lining material---.---- Size: Diameter----------------- - ---Depth---------------------.----------- ys Cesspool: Distance from nearest well-----------------Distance from foundation___ ---- -----------Lining material-------------------------------------. ❑ 517e: Didme'fer--------------------------------------Depth---------------------------------------------------Liquid Capacity_. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------_-_______----.-.-..---_----.------- ❑ Distance to.nearest lot line-----------------------------------------------------------:;------•----------------------------------------------------------------- Remodeling and/or repairing (describe):-------------- ------------------------------------------ ------ -----------------------------------------`--- --------------------------------------------- 6 . --------------------------------------- - ---- --------------- -------------------------------------- _- Y -------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------w--------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, and r lies and regulations of the San Joaquin Local Health District. (Signed) ��---- ---- JL "`------------------------------------------------------------- (Owner and/or Contractor) By:--------------------------------:----------------:---------------------_------------------------------------:-------------r ------(Title)---------------_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l —� APPLICATION ACCEPTED BY------Vii--8-0< --------------------------------------------------- DATE------- REVIEWEDBY-------------------------------- ------------r--------------------- ---------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----------------------------- ------------------------------- Alterationsand/or recommendations-------------------------------------------------------------------- ---------------------------------------------------•---------------------- ---------- ---------------------------------- - --------------------------------- --- ------------'----------------------------------------------- -----------•----------------------------------- --------------- ------- --------• --------------------f---------------------------------------------- ----------------------•- ------- r .................... ...................................../../........__.____.L..._ __._._-..______--.._.-..___. FINAL INSPEC -- ----- - --- - Date.- ------- - ---------------------------------- SAN ------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.DD. Y