17980 - Laserfiche WebLink

Home Browse Search

FPR OFFICE USE: '- Permit No. ,- �l . �(---------------------- _" o APPLICATION FOR SANITATION PERMIT � I ------- ------- - {Complete in Duplicate). ------------------------ - Da+e Issued __0 �-1 " > This Permit Expires 1 Year From Date .Issued -------------------------------------------- Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described, This applicatiori is made in compliance with County Ordinance No. 549. li. JOB ADDRESS AND LOCATION..._ 3- z, Phone------------•----------------------- Ibm OwnersName---------- -i-- ----------� -------- •--------•--------------------------•-- ----•-�------------ - Address ----------"-----------------. -------------------------------------------•--•------•---"----------------------•--------.�_•- ----..- -------------- � -------------- Phone..--..-----------------•--------5. Contractor's�Name------- I ---- -- ----- - Installation will serve: Residence [Apartment House ❑ Commeltial ❑ Trailer .Court ❑ Motel ❑ Other ❑ INumber of living units: ---I---- Number of bedrooms _1 Number of baths _�"---_.Lot,size _-Y7s5,/ -��-- ----••--•- 9 Water Supply: Public 'system-,M__Community system ❑ Private ❑ Depth to Water Table " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan El 1-1 Previous Application Made: (If yes,date-------------__..--f No ( K New Construction: Yes El No [ FNA/VA: Yes No ❑ 1 4� TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic k No aof aom arnce from n�arest well-----------------Distance from foundation--------------.----.Material--.---------------------••------ - / ySize---------------------- ---Liquid depth----------------- -------.Capacity------------------ i []f��✓ p +mems-------------------------- � 1 l 1 ---.-- -""--Len th of each line-"""- -_Ca__-f -N/id}nce to nearest lot DisV I=iel Distance from nearest well___ +_.- Distance from foundation""�f,�___."_-__.Dista- of french.-."--_"c2-_�--H"""--_-3____ /f. Numberof lines`-------------- g �I Type,af filter material""��G-�-------Depth of.filter material"__�_ _"�__-----.--Total ;length__-" _ __0-----`------- - -------- Seepa Pit' Distant to nearest:well--_ �"----- Distance from f ndation ___.-- Distance to nearest Kline-.s--!--.. r s , -Size: Diameter"". "3 Deptn--- `� Number:of pits.--:T'I----"--------Lining material----.�--- -- 1 3 l Cesspool: Distance from nearest well----_--._-."_-.._Distance from foundation--------------------Lining material-".-___"-__"--_". tN -- ---------------------Li uid Ca acit gals. ❑ 5ize: Diameter= - 1 -: Depth_.-. ---------- 9 Capacity I lI 1 4 Distance from.-nearest building---------- ------------------ ----- V% Privy: Distance from,nearest well-_--------._---.-----_ ❑ Distance to nearest lot line-------------------------------------------------------------- -----•--------------------------------------------------------------------------------------- �I F1 ------------- ----------------------------------------- Remodeling ---------------------------------------- Remodeling and/or repairing,(describe):--"_.._.."_ 1 r `( -------- ----------------------------------€ --------------------------------------------------------------------------------------------- ------ ------------------------------I ----------- ---- - 3 t l I r �r. I`hereby certify tha+'l havei prepared this application and�that the work will be done in accordance with San Joaquin Coi my ordinances, State laws, andccruul�le's.and regulations of the San Joaquin Local Health District. II `,d�'" '-.�--��1> ------------------------------- - (Owner and/or Contra +or) Sint1d '-= -------------------------------------------- ------------------ 9 )------------ ------------------ le)--------------- ----------------------- I kBy=--------------•-------------•-------------- (Plot ----- --=(Plot plan,.showing size of lot, lots.ion of.system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY ---------- DATE----- '' .--- . ' APPLICATION ACCEPTED BY: :�_ r_... "-r. s.��- -- ------------- - �- ---• --- -� •----- TE REVIEWEDBY------------------------------- ------- --- ----------------------------------------------- DA DATE------------------------------ ---------------------1------ BUILDING PERMIT ISSUED------------------------------------- -- g, Alterations a or r commendations•----_----" - :. �: f ----------------------_ - ----------------�------- qa/ z r ---------------------------- --------------------- ---------------------------- - - ------------------------------------------- .. -------------------------------------------- ----------------------- ---- -- --------------------------- -------------------------------- ----- - � - -/ � �. Date------- - -- -'��---- -• ----------- -------------- ------=-------- FINAL INSPECTION BY: �cc--------------------------------------- � 1� SAN JOAQUIN LOCAL HEALTH DISTRICT l u 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street I! Stockton,California Lodi,California Manteca,California Tracy,California li �S 9 REVISED E-59 3M 3-'63 F.P.CO. I t /