17674 - Laserfiche WebLink

Home Browse Search

s FOR-OFFICE USE: --------------- ----- --- ------ ---- Permit No. ------------------------------------------------- APPLICATION FOR SANITATION PERMIT m ... (Complete in Duplicate) Date Issued ._7,//--V -, ---------------------- This Permit Expires 1 Year'From Date Issued i --- - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here" 1described. { This application is made in compliance with County Ordinance No. 549. --- _-------- }C t°a:l_ C1f : JOB ADDRESS AND LOCATION----------- ----- ----. a � 1'� ! } 1 f•t"`.—..-. .� ��H"�•� t� --••JT � Phone ---------------- Owner's Name------------------------------------ - ----- ------------------- _ ---- --------- C x 1`� . . ,� H ----- Phone.----•---- ---•----------------- Contractor's -•----• ---------- , Contractor s Name-----------i��--H-=----•-•-•--- --- f----- flrrtfil�i�4-�---- Installation will serve: Residence ®partment blouse•'- Commer(_cial ❑ Trailer Cour❑y Mofie! ❑ Other.❑ 1 .___.___ R_L___________________ Number of living units: _.-�--- Number of bedrooms _._.___. Numbe of baths .�---- Lot size _____..- _ t. Water Supply: Public'_system E3 Community system ❑ Private [(Depth to Water Talble 2 ---- f Cla Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy foam ❑ Clay Loam [] y it F �� FHA/VA: Yes ❑ No Previous Application Made: (If yes,date-..._- _.,_____.-) 'No New Construction: Yes I� No ❑ ri � p TYPE OE 1RSTALLATION AND SPECIFICATIONS: t • . ""'"(No s"efiticfienk`o�cesspool permitted if public sewer is available within 20D feet.} ---- ----- --- Septic T Distance from nearest well �--Distance from foundation___________ ____ _.M t�naL .._____.____ __. • x �_ Ca acit No. of compartments_______----- ---Size__ p - - Liquid depth._._.`_ _ p _17404F I Disposal F' id: Distance from nearest well_.--- Distance from foundation_____________ Distance to neares t Isre..��-__---: Number of lines- ---��------t-.---Length of each line_, _�J-0--- --Width of trench._..____. r } dotal length -��--- .Type.of filter material- Depth 'of filter material------J-7-____-.-._. gI Seepage Pit; Distance to nearest well--- --- ----------Distance from foundation._..___-____.___.._.Distance to nearest lot, int_.___-_____.____. V7 ❑ Number of pits----------------------Lining material-----•------------- ..Size: Diameter: _ .------------Depth-------- --r"- "'------- 4 Cesspool: Distance from nearest well__-____---__ Distance from foundation_.___-_--, -Lining material_ '- -----------------• ��+�""1--'�-.� Liquid C% city------------------------ -9als. i ❑ Size: Diameter---------------- -- ---------------Depth - �,,�-�''� � F f x.�. :� .Dist,ince from nearestjbuildin Privy: Distance from nearest Well------------- -------- -- g --------------- ----------- "" . '*' - = -------- ---------- Distance to nearest lot line------- ---------------- ----------- ----------- --- ---- - ---------------------------------- ------------------- Remodeling and/or reparnng (describe ... .• ------- ___ --; - •-------------------------->--------------------------------------- ` [ - ' Y•------------- -•----•--- ---- - - ----------------------------------------------------------- ------------- --------------------------- I hereby certify that I have prepared this application'an' '`th'at the work will be done in accordancewith San Joaquin County ordinances, State laws, and rules and reguiefions.;of the San Joaquin Local Health District. ) �f .. �x 1 �ycr i T - (Owner and/or Contractor)-- ---- --- ---(Signed] - --- ------------ - - -- - - (Plot plan, showing size of lot, location of system in relation to wells,.buildings, e+c., can be placed on reverse.si a}. FOR DEPARTMENT USE ONLY •—+� DATE } --------------------------------- APPLICATION ACCEPTED BY------r�'-'��--- --<---- --- -- -- REVIEWED BY. = - DATE------------------------------------------------'------- BUILDING PERMIT ISSUED-------- ----- ------------------------------------ DATE --------------------------------------•---------------------------------- Alterations and/or recommendations:------------------------............. ------ - =-------------- - -ss--- ------------- _ - M yti s Ji y _ - - .--- ---- --- ------ ----F - --- -_-- ---- ___• '. l l Wyk Date--- ..._ � FINAL INSPECTIO SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasalton Ave. 30o West Oak Street 124 sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California i ES 9 REVISED 6-$9 31A 3-'63 F.F.CO. _-