17233 - Laserfiche WebLink

Home Browse Search

/ ' E USE: _ � / r� r R � /r� �Oc�FF1C- -- ---�--�(/----- -- Permit No. ---�-�_. 3-� 7f---_ -- APPLICATION FC SANITATION PERMIT ---------- (Cor.71 in.Du licafe `r p } - -- ^�""Da#e"Issued"_7- --_ - - - --- ----- ----'--- i7 This Permit ExPiies l 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 described. This application is made-in compliance with County Ordinance No. 549. 1 I }� 4 Y I. - ' �--- �.t�Y{_. �'� ---------------- I------ JOB ADDRESS AND LOCATION-_-3--- ••--` e-"--------------- 1. -------------------------- �: . Owner s Name-- •------------- - = -----. .a --------- ----- --------------- Address . -::y one--_Yd* -- -. z7 Contractors Name---_- - -- •-- ----------- ` Commercial.-❑ Trailer Court ❑ Motel ❑ Other Installation will serve: s Residence [�Apartment.House ❑ 1� .s - Number of living unitt- r,� ;.Number of bedrooms _- -_--Number of baths ---I--- Lot size ------ J--- -- i. t1 e th to Wa#er Table .____-- ft. Water Supply: Public.system g Community system ❑I Private ❑' '0 P 1 } Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe e Hardpan ❑ Character of soil to a depth of 3 feet:' Sand ❑ 0 y FHA/VA: Yes ❑ Na �~ U: r ❑ :' I 'Previous Application-Made: (If yes,dptes �--------------1 N#C9" New Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: o (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Se tic " Distance from nearest well------- = :--Distance from foundation______ -------�-----.Material `----- Size Liquid depth--------- ----------------Capacity---------------------- No. of compartments----------------- Disposal Field: Distance from nearest well--A(oy Distance from foundation____/^vim--y---------Distance to nearest IoZ�e___ __________ �._.__- -- _ :Len Length of each line--------- �--1---=-'----Width of trench--------------------- ---- Number of lines - 9 i. 2.J•-- --- ------- s e_-t ___Depthxof filter matertial----- ------•---Total length-------------•-------• r O _Ty'e.of•,filter materiai___1Po--- - 1 may: ©� Seepage Pit': Distance to nearest well* h�-------Distance from foundation----/_____---______Dist��a to nearest lot line_-�--_- -- d I ` Number of its---------/-----------Linin material t6°_c--k_-.Size. Diameter------ ------- ----Depth-_-__Z-5----•-- i Cesspool: Distance from nearest well-------------`.--'Dtsttance from foundation.---_--------------.LiHing'materia____.-.----------- --"----------- Size: Diameter'------------------------------------Depth -Li Liquid Ca acit gals. ____:.D.istance,from_nearest..building______ _______________--------I---;6;--O Priv . Distance_frosn.�nearest well______________________i______-- y: 3 ❑ ----------------------------- Distance to nearest lot line._--_-"---.----- - n r rI 1 -- - ---- ---- - -----7•-- ; . 1 - --------- Remodeling' and r repair'ng (describe}: - - ------------ ------- E - ---- ---- ----- ------------------ ---•-- ~' --------------------- ---------•-------- ------ --- -- - ---• }" 1 ► - I hereby certify that I have iirepaied this application and that the work will be done In accordance with San Joaquin County ordinances.":State laws, a rules and regulations of +he S oaquin Local Health District. I € t `---y---- . ------------------------ (Signed) - (Owner and/or Con Factor) _ = ----"------=--- --- - Br• I' ---• --•------- - = ! (Plot plan,I.showing size of lot, location ,of_system,in-r-elation,to.wells,-buildings, etc.,,can,be placed on reverse side). .., FOR DEPARTMENT USE ONLY -- -------------------------- - t�-1 LDATE-•--------- APPLICATION ACCEPTED BY_ # DATE_---------------------------------------- -----•------------ ------------------------------- REVIEWEDBY---------------------------------------------------- -- DATE - ----F------- -------------------------------------------------------------------- BUILDINGy PERMIT ISSU1 D _ --• ---------------------- �.. _ �- . .. ------- Alterations and/or recommendations:-------------------------------------- - 1 _ _ ------- ----- I ---------------------- ---------------•-- •-- .-k,- ------------------------------------------------------- - -i--- ---------------- -----•--- ---------- ------- -------- -- I --------------`-----:- ! --------------------------- - ---- E4'""' i Date-------- ---------------- ------------------ FINAL INSPECTION BY:------- ---►---- --- ---------------- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT 300 west Oak Street 124 Sycamore Street 205 West 9th Street 1401 E.Hazelton Ave. Tracy,California !i Lodi,California Manteca,California Stockton,California CS 9 R£VIr ED 6-59 31A 3-'63 F.P.CO. V