16228 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: — / ,� a Permit No. -__/{. ....... J `3 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) -- n Rafe Issued ----- -.---•-- o ,--- ----.--- This Permit Ex ices 1 Year From Date lssued.�.- g P : • ' made to the San Joaquin Local Health District fora permit to construct and ins#all the work here'sn described. �. r�_%:, Applrca+�oniis hereby ` This application is made in compliance-with County Ordinance No. 549. •-------•---- . �+ :------ ------- Phone G ---- -- JOB ADDRESS AND LOCATION-'—: _I � 1 f1 ----------------- r� Owners Nab e -=w 45� , -.--•---------- � 6� J Address ctor s Name 1.17-__ •- � -------- one . � Other 1 Co t. t Mote! ❑ ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ * umber of baths -->�- Lot size .__�.�--,,02- ------' Q0-•-------- i ti Number of living units: -3--'-"Number of bedrooms_.;. N t t . Priv e Depth to Water Table- ft. }.E Water Supply: Public:system [Community system ❑ d Loam Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ ;t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy 11 ❑ No FHA/VA: Yes,[J No �" New Cnstruction: Yes ❑ Q Previous Application Made: (If yesFdate----- ) No [ i TYPE OF INSTALLATION AND SPECIFICATIONS: er is available within 200 feet.) (No septic tank or cesspool:permitted if public sew Material.................. ------------------------------ ► Distance from nearest well-----------------Distance from foundatiLln`--i-- de th ___-_--------- ---------Capacity__.-__..__----�-I--- - Sep Tangy No. of compai'tlments------- ---------------- Size. G ► P' - ---_-_.Distance to nearest lot line_____ ________ I Width of trench ` , Disposal Feld: Distance from nearest wellIV Distance from foundation"__.- �? ,: Number of lines-------------�---- --- Length of each ,Dine{`"_---- "� a _ , r , ,.Type.of filter matenaL___-�P�----Depth of fi4ter,material__-- �_ -'--.Total length-�_____________:_� ---------------- .— " , yr t /VGr Distance from foundation-_c ,S_..___.--.Distance to nearest lot line Seepage Pit: Distance to nearestwell- - -Q- - x__� Number of pits ----- g • _Linin matenaL__��---��.---Size:i Diameter_----------� ........Deptn-------------- ---------------- r p + tr g . Cesspool: from nearest well-- ------------ �} ce from foundation-_-- --- Liquid Capacity gals. P e Size: Diameter__ ___-__ : ❑ Distance from_nearest well_. _-- _____.-Distance from nearest building_____--------n---- ,-==- - Privy: ------- - -- ------- Privy: ❑ " Distance to nearest lot line..__----_---- "' l t / c5 - ------- x . r� Remodeling and/or`repairing (describe):-_- - { # ------------------------------------=---------------------------------------------------------- x --- ------ ` ------------ *. t .. ------------------------ --•--�---------; ui i ------=----------- - -- --- - ---------------- -------- --- .,� — - 1 herebytertify that I have prepared this app lication andlosui�hLocalkHealltheDistrtctn accordance with San Joequin'County ordinances, tate laws, and rules'and regulations of the San q ►•t - 't � (Own rand/or Contractor) r (Signed)---- -• - -- ----- --------- ____ --(Title)_ show size of lot,�� ati n of system in.relation.to wellsrIy,y ---•By:.-----q -------- , buildings, etc., can be placed on reversesi e.-•.,,..•..•�•�,+ (Plot plan, g t i FOR DEPARTMENT USE ONLY 5------------------------ - DATE--- t 3- ---------------------------- APPLICATION ACCEPTED BY.____.�_-.--- _ ----- ------ ----- ----1-- -------------•------• DATE-------------- ---------- ---------------•------------ REVIEWED B ------------ - ----------- - "- - ------------ DATE_-__------------------- . BUILDING PERMIT ISSUED-------------- ------------------------------------ - -- ' ---- ( Alter tions and/or recorrimendations:__- !`'" a -•- 1 C� --------- ---------•--- ._.. _ _S, ------------------- --- - -------------- t - --------------------- ------------------- --- ------------------------------ ------------ ----------- ---•-------- ------------- - ; --- --------------------- ----------------------- ----------------- - ----- --------------- --- - �. ---- --- ----- ----------- ----------------- a-- - Date--- FINAL INSPECTION BY:____-�--�- ----------------------------- FINAL - -" i H.DISTRICT SAN JOAQUIN LOCAL. HEALT i205 West 9th Street 124 Sycamore Street 1601 E.Hazelton Ave. t 300 West Oak street California } Lodi,California Manteca,California Tracy, Stockton,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.