14127 - Laserfiche WebLink

Home Browse Search

FOR OFFl7 UE: I J I APPLICATION�R SANITATION PERMIT Permit No. .l...- r 4 -•-------- --- -- --------- ------------ t (Complete in Duplicate) ,ate Issued Date Issued .._.. �. ...12� ----------- --. Is Permit Expires 1 Year From D E 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. 543. •• r JOB ADDRESS AND CAT N-_-�+ 'y ___ - _4W ---------------------------------------------------------------------------------------------- Owner's Name-------.... Phone . -A. -----------30 Contractor's Name................. -----------•--------------------------------------------------------'I--'---- hone...----••--••----:................ Installation will serve: Residence Apartment House ❑ Commercial ❑�.Trailer;Court_[=-]_Motel.0 Other ❑ Number of living units: .j--- Num`6ie of 156&66,a'42_. Number of baths' /'._J Lot size._./. 0. E --------------I—---------- Water Supply: Public system5=�C�xnmunity-system-❑-.-Private d Depth to>Wa'ter Table '! ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy!Loam ❑ Clay Loam ❑ Clay ❑ Adobei•5Ugf ardpan-❑ Previous Application Made: (If yes,date---------- ---------) No ggo"New Construction: ;Yes❑ No g�'FHA/VA; Yes ❑ No g4-' ' TYPE OF INSTALLATION AND SPECIFICATIONS: t Z (No septic tank or cesspool permitted if public sewer is available within 200.feet}) � . Septic Tank: Distance,from nearest well_________________Distance from foundation=____ _-_______f'_.Material______--____---__-_-- ........................... No. of compartments--------------------------Size-------------4-•--------- ---Liquid dei'h__-----•-----------------Capacity.--------•-...-•--•-•-- Dis Disposal Feld- Distance "` � 7/V _Distance to nearest lot line..4.�----.- P � 1 • &,,1�' Number of lines earest a t---- Length of each line$t� ____ —-----Width of trench.. ----------------------- ----------- Type _______________---__ \ y,f� �' �.�--......mow, a' yP �/ p material"-------Total length----jO. ----------- Seepage -- �1 T e of filter material � 1--Distance Depth of filter See a e Pit: Distance to nearest well____. __}mD+ifaanlce f m f undat�on__s_f�_!__..Dince to nearest lot-iine_.. �__. P g Number of pits...__ Lining ______ Size: Diameter ____-_._.... Depth; o�� (� Cesspool: Distance from nearest well_ ____Distance from foundation'__.----------------Lining material....`_A4_-_____.___.____________ ❑ Size: Diameter--------------------------------------Depfh__` - Liquid Capacity gals: NZ Privy: Distece,from nearest well-_______________ ___._-__ '�.-;c/_D"istance from nearest building------ ❑ Distance fo nearest lof-14)6—'... = .--------•------------------------ Remodeling and/or repairing�(dorscrlbe)--------------_ - --------------------------------------------••------•--------- = ------------------------------------------'•••------•-t---------------------------------------------------------------------- ------------------_ I ---------------------------------- ---------------- ----•-----------------.._-...................................•........ --------------------------------- •..1 --••-----------------------•------•---•--------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and +b-at the work will'be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local HeblthDistrict. Ilka (Signed).. - --- ---- ----------- ' _.... ---------'-------------....------------- or Contractor). 5 t j t i ey- •----------- T-:..... (rifle) (Plot plan. showing size of lot, location of system i ation to wells,"buildings, etc.; can be placed on reverse side). , FOR DEPARTMENT USE ONLY; APPLICATION ACCEPTED BY--- - .......... ---------_ .-?-------- . - - t -- DATE---- _._..------------. ........ DAT ----------_-------REVIEWED BY--•---••--------------------- ---- , . T BUILDING PERMIT ISSUED.. - DATE----- -- ------- Alterations and/or recommend'ations:__- -` _o ------ .. - -• .----- - �- --- ---------------- --------- ..1 — -------------------- k .. 4y p' �=�•------ E -----_------------------------ A, --- ------ --------------WIX ,________�--_Lam -. __ ___ __ _.__4___-.__.____-_-______.__�__.!:_�-- - ~----------------------------_-_____-__________--._________ _________--_..________-.__._. FINAL INSPECTION BY----------------- ----------- --- ------------------------------- Date--- ------- ---.._ �f.SAN`J.QAQUIN:LOCAL HEALTH DISTRICT 130 South American Street 300'Wost Oak Strut 124 Sycamore Street 205 West 9th Street Stockton,California "lodi`Capforrrla Manteca,California Tracy,California ES 9 REVISED 8-59 $M 8.61 ATLAS