19268 - Laserfiche WebLink

Home Browse Search

ICI-1 FUP, OFFICE USE: r ------------- -- ---------------------------------------- --------------- -----1--------------—------- ------------------------------------------------------------.---_-..----__..-.---.- --. APPLICATION FOR SANITATION PERMIT Permit No. ._..._9.....�-� -------------------------------------- ------ (Complete in Duplicate) Dissued --------------- --------------------------------------- This Permit Expires 1 Year From Date Issued ate �---��--S Application is hereby made to the San Joaquin Local Health District for a permit to con truct an install the work herein described. This application is made in compliance 7th County Ordinance No. 549. v� 7-e,57 W Q .f r JOB ADDRESS AND OCA _- �"6 .��, �Q Owner's--Na / .. --------- '----- -- ----- ----- ----- Phone---------- Address � - _ ------------_- -------- -- _a - ' Contractor's Name---- T r ---------•---------- ------ ----------------- Phone. ...-.... ------ Installa+ion will serve: Residence Apartment House 0 Commercial ❑ Trailer ourt ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedroomsNumber of baths ---.--_ Lot size _-. `1C1- �✓LS�--_--_--------_-_ Water Supply: Public system ❑ Community system ❑ Private �pth to ater Table!---- ft. Character of soil to a depth of 3'feet:Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ q � Previous Application Made: lit yes,date--_-- -----------) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ N TYPE:OF INSTALLATION AND. SPECIFICATIONS: � (No sep+ic tank or cesspool.permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance`trom foundation-------------------Material-----_-____---____---- y ElNo. of compartments--------------------- ---Size-----------------------=-----.-Liquid depth---------- --- -----------Capacity-••------- ---------- Disposal field: Distance from nearest well--_ d--_-;Distance:-from foundation----�-d.--.--.Distance to nearest lot line--- ----------- Number of lines__-.--_-- . ea Length of• ch line------- ._ G---_----..Width of trench.--. - Type.of filter-material---� - ---- -----Depth of-filter material-----3�__ - --.-Total length----�-- -- •-------------------- ---- Seepage Pit: . Distance to ne resf well--------.---------------Distance from foundation--------------------Distance to nearest lot line-------_-------- ❑ Number of pits___-___-----_.___-x_Lining material_ ____----. 'F f ..Size: Diameter---------- ------------Depth--------------------------------- . li Cesspool: Distance from nearest well--_" --- - ----Distance from foundation----= --------------Linin material--------------------------------------- ❑ Size: Diameter`. : '-----------=--------------`----Depth----------------------------- _ Liquid Capacity gals. j Privy: Distance,f�om.nearest,`well-:_----_._- `` ---__----__-- --------------Distance ffom nearest building__ -------------- Dlstance to.nearest•lot. Ina---- Remodeling and/or repalrmg (descrlbe). --------- ---___- .. ---------------------------------------- Z - = ----- -- =-•------ -----------------------------------= -f "► --------------- ----------,--- :---------------------=---•---------------------------=-------_== ------------------------------------ -------------------------------. . ------------ -- e- 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 and'reguiations.of the,San Joaquin Local Health District. - (Signed)------ = fand/or o f t -= --- --------------- -------------------- ------ BY� : = --- - -------- - .F c ' •" Contra or - ------------------ ----------(Title) --------------- -.- ._-... ................. . (Plot plan, showing size of_lo+, location of sys em in rela+io fo wells, buildings, etc., can be placed on reverse side). '_. - f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -z- l "---------------------- ----------- DATE--/ ----�--- �------ --------------- ------------------- REVIEWED BY--------------!-------=---------------------------- -- -.. DATE------- ------------------- BUILDING PERMIT ISSUED------•-------------------------------------------------•-------------------------------------- DATE------------------------- Alterations and/or recommendations:_'•---------------- _ ,-------------------------------------- -------•-----•----•-- ----------------------------------- I I - - - ------------ --------------------- -------- ------ --------- ------ --------------------------- --------------------------------------- FINAL INSPECTION BY:.. !!�'d' ------------ Date-1" - ------- -------------------- --------- 1 j SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hdxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8--S4 3M 3••63 F.P.uo.