17350 - Laserfiche WebLink

Home Browse Search

*vK VrpiCt U,)t: ------------------------------------------------------ --"......................................____----_____ APPLICATION FOR SANITATION PERMIT Permit No. ...1.... . ------- ----------------------- ----------------------- - (Complete in Duplicate) - ---------"..-".--- This Permit Expires 1 Year From Date Issued Date Issued ____ Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstall the work herein. scrbe This application is made in compliance with County Ordinance No. 549, Q s. GIG ,cam JOB ADDRESS AND LOC TION---- --� ," �'J� Owner's Name-------- - - ------+ -----C-t--•-C------') Phone / ------------------------ -- - -- -------------------------- Address----------------------- I .r_/ v v _4. -----------------------------•---•---•--•------------------------------------ Contractor's Name------ � Phone----------------------------------- Installation will serves Residence's Apartment House ❑ Commercial E] Trailer Court ❑ Motel n Other ❑ Number of living units: _� Number of bedrooms _:7;?�,Number of baths __/-___ Lot size ------------------- Water """""" ""Water Supply: Public system ❑ Community system ❑ Private &P, epth to Water Table3�t. Character of soil to a depth of 3 feef:= Sand ❑ Gravel ❑ Sa y Loam ElClay Loam E] Clay C] Adobe ardpan ❑ Previous Application Made: (if yes,date'------------- ---) No New Construction- Y o Ej,-"FHA/VA: Yes ❑ No fg '' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic T Distance from nearest well_-SP./---Distance from foundatior�/ --------Material"-d% _A9�(&r- No. of compartments_____-_2-__._-____-"Size____ ..(�_ __ __ .___Li Liquid depth p ------- ----------- "--""" ®' /1 ,� � q P. ��-- CapacitY--- --- Disposal F' Distance from nearest well-.. �___ #Distance from foundation-,,/d.-_-`__._.Distance to nearest lot line.S'/.___.. Number of lines,-------�------------------------ELength of each line-------� -_ ._""-"-- Width of trench.-- -- -f'___--------"--- Type of filter material__-_J Z.?&:depth of filter material----/,f"_r,.""-Total length---------_�- --------------- See pag it: Distance to nearest well--- "-;Distance f m foundation---1AP__°._.Distance to nearest lot line__._a�./ P7�It Number of pits------1---------_---Lining material___ Size: Diameter_,3��-ice.._"_Depth_____. Q. r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------2 .___-____.___--_ ❑ Sizer Diameter--------------------------------------De.'Depth - - - -- - ----------- -Liquid Capacity-----------------------------gals. � ance from PrivY: pi f ante to nearest lot I ll- ----------- ---- ------------- ------------ °_Distance from nearest building----------____________---___..____-____ ❑ �s ----------------------------------------------------- ---------------------------------------------------------------------- 44, Remod n ,or rep6i -_.e';2 ------`--- ing (describe):__- . - _ -- -----------------a----- ----- -- -- ------ 1� ----------------------------------------------------------------------------------••----------_-------:.-----r— ------------------- I hereby certify fhaf I have preed this application and that the work will be done in accordance with San Joaquin County ordinances, State 1 s, a rules n r ulations of the San Joaquin Local Health District. (Signed)----------- - -� ;----- L--- -------�-- ----- - -----------------------------------------------------------•------------------�/ -(Owner and/or ontractorl BY: - - - -- �- �_------------------------------------------------- ----(Title ,,-(Owner -� (Plot(plan, showing si lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}: - a y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----.---------"-----'---------------------------------------------------------------------------- DATE-------- ---_77273"-- REVIEWEDBY----------------------------------------------------I---------------------------------------------------------------------•- DATE-------------- ---------------------------------------- BUILDING PERMIT ISSUED-------- ------------------------- ------------------------------------------------------------------- DATE-------------------------- Alterations and/ormmend do ---- � _____ . -------------- - ---�. == --- +-------1 t 1 --------- ----------------gi p - R. n --------- ----------------- --------------------------------------- -- ---- ----- ------- --- ----- ---------------------------- ---------------------------------------------------------------------------------------- FINAL iNSP ON BY Date------------- - > F SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street tl Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CG.