16352 - Laserfiche WebLink

Home Browse Search

FOR/OFICE US�� "�-� � iJ� �l r- Qox --- ' APPLICATION -FOR SANITATION PERM Permit No. l_f1.1_ �------------ -- r - (Complete in Duplicate).- -------------------- uplicate)._ 9/j ____________________ ---------------------.__._.:_ This Permit Expires 1 Year From Date Issued Date Issued M_.._.-_�__. _ Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No._54/9 f X533-�_N. �-• A,�.- • �� D g l 230 �r JOB ADDRESS AN LOCATON-//-,- -- --. ` y� Owner's Name_ / � �>f Phone Address 1-712-_=` �/l� Contractor's Name---------- JJ _= . rte Phone----•----------•------------------- . Installation will serve: Residence Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: _____,Number of bedrooms .X_ Number of bathscsZ.-Lot size __�i�,t�� _l- : Water Supply: Public system Community system kmPrPrivate ❑ Depth t Water Table6d__ ft. 1 Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date---------.-----------) No U--<ew Construction Yes E], O ❑ FHA/VA: Yes [c fVo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) - Septic Ta Distance from nearest well---__ ---Distance Distance from foundation/e-- .........Materia _._-__________- No. of compartments----sem--------------Size-_ _Kd___-__.___Liquid depth_4 .--_-_---Capacity__,/dT_a-_-.--_ disposal -cld: Distance from nearest well.....------I...Distance from foundation f-------- Distance to nearest lot line_ --_____- W Number of linesi-.----A---------------------Len th of each line-'---- ______________Width of trench`.� � o 9 -------•--Total .len length-- p ` '1� Type of filter material___ __`! i�'�� Depth of filter material)-e/f_ 9 �( /c,> r Seepag rt: Distance to near:est well---__ .--Distance from foundationtCQ_�._-___.Distance to nearest lot line_��_�.__- • `• - ��---------DepthCQ _0�4------ Number of pits------ --------------Lining matenal�___J�_=___-.-Size: Diameter-_ Cesspool: Distance from nearest well-----------------Distance from foundation------------.------ Lining material---------------------------:--___- .- ❑ Size: Diameter--------------------------------------.Depth----------------------------------------------------Liquid Capacity----I--------------------_gals. Privy: Distance from nearest.well--------------------------_----------------------Distance from nearesf building------------------------------------_----. x ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------- r — 1 . --------------------------------------•-----------------------�-------•-------------------------------------------------------------•------------ ----- -- ---------- ----- ------------------------------ ------ -------------------------------.------------------------------------------------------------------=•---------------------- -----------------------------------------------------------------------------••----------------------------- •----- ------------------------------------------ ---------------------------------------------------=---- Ihereby certif at I have pared this application and that the work will be done in accordance with San Joaquin County. ordinances, State cert! a and r, es d regulations of the San Joaquin Local Health District. (5i ned 9 )----- ----- ---- --- - ------ ----------- (Owner and/or Contractor] By: ------ - (r+le) (Plot plan, showing size t. location of system in relation to wells, buildings, etc., can ber placed on reverse side).,. i I FOR DEPARTMENT USE ONLY ------------------------------ DATE----- ~f>l �y ---APPLICATION ACCEPTED BY------- --- i�}----- -- ---'`----------------------------- ---------------- REVIEWED ----------- -- REVIEWED BY-------------------------------- ------------- ------ - ---- ---------------------- DATE------------------•----------------- ---------------------- BUILDING PERMIT ISSUED----------------•------------------ -------•-------- ---------------- DATE-- ---------------------------------------------------------- -------------------- Alterations and/or recommendations:._-______-- 5--__`4 - _ "`: - :- - ��_-__films- ✓_._.__- _1`.__ � ----------- ` r ' of r'` =` -�'L-� = s-'' 'z �' /C.---- --------------------- ----------------------- -----------•---- --- - ----•------------------- ----------------------------------------- -------------------------------------------------- ------------------------------- --------------------- } �G1�l�� - �� 7-1 Gl FINAL INSPECTION BY:.- 41;-------�--- --------- ------------------------- Date--------------/---- --------------------------_------------------------------ 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 1 ES 9 REVISED 8-S9 3m 3-'63 C.p.pp.