18519 - Laserfiche WebLink

Home Browse Search

r� FOR OFFICE USE: h -------- -------------------- Permit No. .11J_11 _ ----- APPLICATION FOR SANITATION PERMIT ------------- --------- --------------------------- , tr (Complete in Duplicate] Da+e Issued aZ - --- �A "_----"--__.._-_ 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 herein describe This application is made in compliance with County Ordinance No. 549.. ? I JOB ADDRESS A OC ION.____-^-�� - �--- -- ---- ----- -.-- .... . Phone- -------------------- r f . -------"""""`Owner s Name__ ____ �42 t -L-----�--- ---•---- ----•-- ---------------------- Address -. Address.---- - ----------•-------- Phone--=---- Contractor's Name----------_ - --- ----- -- Installation will serve: Residence Apartmen House. Comerc*0- ,_,n Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number ofbedroo � mber aths !1.___ Lot size __- _."�j�-- ----- - . . .� . ..r..—:... ""1Neter Supply Public system ❑ Community system ❑ Private .. Depth_t star Table _______ ft. depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ciay Loam E'] Clay El Adobe❑ Hardpan ❑ Character of sail to a dap � No El Application Made: (if yes,dafie____..__ No -_,_...._._) ;No ❑ New Construction: Yes ❑ ❑ PHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (N septic tank or cesspool perrnitted if public sewer is available within 200 feet.) � Sept ank: Distance from nearest well_.= _ .__Dista e,/frw, Rnd t'9n__.__ ---'-.Materl___.. "(f -Q' ------ No. of compartments"_-- : ` _ Liquid depth'----- -_ -Capacity___ - . . J,, �`- `= , i J0n---____".Distance to nearest lot line" _ �.__-'Distance from foundation__-. �. � —40 Dispos geld: Distance from nearest wail_ -- ___:' ¢ f k9 f F 1 Number of lines_"____________ __ - Len'th of each line_-_.__. ��. .____ __.Width of trench_._2.___" ____..___..i Depth of filter material------/_-jf---- --Total length-----. --- -- -------- Type of-filter.material .t -- -� p a Seepage Pit: Distance to nearest well______________! _C}is#once from foundation---------------------Distance to nearest lot line_"""----"_-"---__ nin material Number of pits----------------------Lining 4material----------------- ----.Size: Diameter----------------- -- - Depth---------------------- El g Cesspool: Distance frorri�nearest well-----------------Distance from foundation____________________Li -- gals. Size: Diameter- - ----;----Depth---------------------------------- ---------------€-Liquid Capacity---------------------------- , Distance_from nearest building A � Privy: Distance from nearest well-.- ---------------------- - g .I------ Distance to nearest lot line----•----------- - '------------------ --------------- ------------------------------ Distance =' ---- I b �`%� ^P d .7_ _ .�i - ({ _ v:.:i�._. ---------4-=-_____• 1 Remodeling and/or repairing (descrsbe):_--__... :_ ; ✓�-- •�� 6 `' /- - --------- i -; -- t x Y f _� ---'------= -----------------••------------------------------- ------------------------------------------ t - .r,..r >`sa �> �.x ------------ ----- - 4 that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this application and k ordinances, State laws,janrules and regulations of� a Joaquin Local Hfalth District, _ /or Contractor) Si ned # ---- -- ----- -------------( ci - - -- _ ------ By:--------------------- --- .I- -- -- ... - -- --- ---.�--- -`; ---- --------------------------(Title)- -o (Plot plan, showing size of lot, location on of system in re ati n towel s ildings, etc., can be placed on reverse side). d i FOR DEPARTMENT.USE ONLY T ------ APPLICATION ACCEPTED BY___ . �j DATE DATE------------------------------------------ ---------------- /B5 . REVIEWEDBY--------------------------------------------- --------------------------------- ------------------------•---- DATE--------------------------- ------------- - ------------ BUILDING PERMIT ISSUED--------------------------------------------------- --- -------------- ------ ------------------- Alterations and/or recommendations:------- ------------------------- ---------- - -----"-------------------------------------•---•-------------.... -k ________________________------------------ ------------------------------------------------------------------------ -------------------------------- ""----------- ----------.____.. ------------------------------ -------------------------------------------------- - Lsr.- ------- i FINAL INSPECTION BY: ----- -- .1-'G--Y'-- ------------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street i Stockton,California Lodi,California Manteca,California Tracy,California y 95 9 R£vl5£D 9-59 3M 3-'63 F.P.CO.