17124 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: /) -24, .2,2,4Z2_3 ------------------ ---------- --- ------ '------- /� X71�--.:/ ',APPLICATION FOR SANITATION PERMIT Permit No. .. ..... ........ (Complete in Duplicate} € Date Issued --- -------------------- ---.--�--------_--7 _____________________________ This Permit Expires 1 Year From Date Issued ! Application is hereby made to the San Joaquin Local Health District for a permit to ctruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION__ �__.�_ __ _ f -- c{-- --- C.. ------ ---- ----.... Owner's Name_)Illi 1-/- ' n _. t � ¢ ---------------- -" ----------------------------------------- 11----------- Phone-5 --- 5_2-i7 4-- Address-------•------'�-&-`T`_-- 4 r--ll.--•---=------ ------------ i� - ----•--------------..----------------------------------------------------------------- Contractor's Name_- k f.-__._ _t '------------------------------•---------- one__ f JIF12Z a Ph Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ F Number of living units: I____ Number of bedrooms_,;_._ Number of baths _/I�ot size ---------- __________________ Water Supply: Public system ❑.. Community system ❑ Private ❑ Depth to W ter Table ________ ft. 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 ❑ No �HA/VA: Yes ❑ No ❑ TYPE"-O•FTINSTALLATIOIV AND SPECIFICATIONS: �' No septic tank or cesspool permitted if public sewer is available within 200 feet.) k S �Y� 1T kDistance from nearest well_________________Distance from-,foundation--------------------Material------------------ ------------------------------ . { C ►' '�No. of compartments- ----------- -j--Size------------------K-.---------Liquid dept, .Capacity �J �r Di _sal~f QId-._c Distance from nearest well .0......Distance from foundation.____ _. 1. �sa7____._.Distance to nearest lot line--A#2-4' ._____ O Jjr � Number of lines_____�__�Q_ __. Length of each line-------- (_.Width of trench__a �i�`�-__rf___ T e of filter matena"[A? ____ _._-Depth of,filter material___.______� ____._Total length_____________________'r�ca�---------- b YP ! 1 Seepage Pit: Distance to nearest well-" -----------------Distance from foundation________._-_-._____Distance to Jot line__-_____________. u. ❑ Number of pits- ----__Lining material-----------------------Size: Diameter------------------------Depth---------------"-_--- --------- Cesspool; Distance from nearest well-----------------Distance from f'undation--------------------Lining material------.-__--------______._________.__. ❑ Size: Diameter--------------------------------------Depth-------- Liquid Capacity---------------------------gals. Privy: Distance.from nearest well-------------------------------------------------Distance from nearest.building-------------------------------_.______. ❑ Distance to nearest lot line----- --------------------------- - -----------------------------------___.-,-----------=------------------------------------------------- ro Remodeling and/or repairing (describe):--- _ - ---------------------------------------------------- - r +_ � -------- -: -- --------- ---- --------------- /�y�p/� p�/�] T `'-//!S• C�!_....` - ___ _�� 1/may////� L�-• Y l //TfJ/f / 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 rules arid regulations of the San Joaquin Local Health District. ,,,,�� -- c !/ - ------------------- - �of Contractor} (Signed}_ ?.0----- 1 l - - ,.�,�. �.. s.d... -- �---- -----Title 8Y� -------------------------------------- ----------------------- (Plot --- ----------- r = { ) (Plot plan, showing size of lot, location of system in relation to wells, buildings, c., can be placed on reverse side). } FOR DEPARTMENT USE ONLY d ------ , APPLICATION ACCEPTED BY"------- -- ------------------------- -- DATE------- ---------------------- � ---- -- -- -&-- ------------------ REVIEWEDBY------------------------- -------------------------------------------------------------- --------------I------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------- Alterationsand/or recommendations------------------ ------- ---------- - ---------------------------- ------------------------------------------------•------"--------------=:--------------- -----------------------•------- ------------- --------------•-------------- -------------------------------------------------------------- I ---------------- -----• ---f------------------------- -----------------------------------------------------------------• ------------ -- I. ---------------- -------- ----------------------------------------------------------------------- --------------------------------------- -------- y �I _.._ FINAL INSPECTION BY:-----�-_- )-------- Date------------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. -x.300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CO.