16803 - Laserfiche WebLink

Home Browse Search

FUK OFFICE USE- -------- ------------------------------------------------- ------------------------------------------------_.-____- APPLICATION FOR SANITATION PERMIT Permit No. :' 4 (Complete_in Duplicate). !, -----------------------__---------------- - ----- This Permit Ex ires 1 Year From Date Issued Date Issued --- --- A7-(--� lication is hereby zd� ~ oko—v ' Application y 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 Count Ordina ce No. 549. r . - — v 1 JOB ADDRESS AND LOCATION- f '� / �.�aSL ----------t-------- _ _ ... T.ei9 ,f-- Owner's Name--------- - Address. 1 ` -`�-- '------ -'�-- o c? ♦__�i11... -------------•---------- sS Contractor's Name-------•------`�1rCS/j� 1 '' Phonwo 6 - - . Installation will serve: .Residence-0 Apartment House-E] Commercial R1 Trailer Court -E] Motel p Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths _4____ Lot size _____________f Water. Supply: Publics stem I pP Y� Y ❑.. Community system ❑ Private �R Depth to Water Table _;F0. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: ilf yes,date______ ___________1 No J' r New Construction: Yes ❑ No FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: .i-(No septic tank or cesspool permitted-if}public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__S_-0j0_' --Distance from foundation._- 1 .Materia No. of compartments----------- -:-----------Size_8X S_.X-�------_---Liquid depth------!_y-'-----tea acct P y- - , Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_______-_...___ ❑ 'r?�ST�Nd Number of lines-------------- -------- Length of each line-------------------- ----------Width of trench_ ------- _.___ --- Type.of_filter-''material-----.- - _Depth,of flter,maferial ------------------Total length---------•-------------- -•--- Seepage Pit:�Dis#ance fio nearest well.___ r ____ _____Distance from -- --------- Seepage to neares#.lot line_______._..__ " ❑ �tj,fi N6 Number of pits---------'----•-____--Lining material----------'----_------Size: Diameter--'------'--------'----.Depfih__'------'----------------"--". jCesspoolL Distance from nearest well_________________Distance from foundation___.-..._-: ___.-__,Lining material-___._________-___..____._ ❑ 5iie: Diameter___- ----- --- - "-Depth - --- ---" -- --- Li uid Ca acit - ---------' i _ .-�: .rte.-x ik -:ti, �_, .. q. _� p_, Y _ ga�u � Priv . -'stan e.fr.m nearest well � "I y ` l y'. -- _--___ __ ---___._Distance from nearest build+n Distance to nearest lot line._._"_ - �` Eta �` ` �. . ate Remcd . 9 and/or repairing (describe)_______________ - "" ------------- --------------- _ - -----�---' ---------•--------------------------------------------------------- -/ r`zc------- Tr3i✓ .. 's �Y,�G T ---- ------------------- , -- ---- [ --- € ----------------------------------- - ------- --- ----- ------- 1 hereby certify that I have prepared this application and that the work will be done'in accordance with Sa`n�'Joaq-- Count} ordinances. State laws, and rules and. regulations of the`.San Joaquin Local Health District'. {Si ned r y ® f g ) f ----( caner. and/or Contract -$Y�; = _ - = -----------•--------------- (Title) -- _ - Cw�j . (Plot plan. showing size of lot, location of stem in relation to wells, buildings, etc., can.be placed on reverse side). \�. ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------'--------------------- ---------------------------------------- DATE REVIEWEDBY-------------------------------- -------------------------------------- ------' 'DATE BUILDING PERMIT ISSUED i --- -' ------. DA•TE---------------------------- _---- __ ' +can t'.. ___ ----------------- ___ Alterations and/or recommendations:__._________________ - i ----------- -------------------_----------_------------______----------------- --------------- ------------------_----------------------------._.---------.------------------ t __________________________________________________ __ _ ___ ______________"-._ FINAL INSPECTION $Y:. ----------- ---- - - -- ---- - - - Date-------------- /w� / Ea- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore street 205"West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California £B 4 REVISED 8-S9 3M 3-'63 F.p"co.