13372 - Laserfiche WebLink

Home Browse Search

FOR OFFICESE: -f'-- f/i ! . f3 6 Permit .o APPLICATION FOR SANITATION PERMIT �,• -�.• -- - IN-__ [Complete in Duplicate) M!_yA'/ - ------------^-----------------------'------- -- Date Issued .._ "- This Permit Exioiires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and sinstall the work herein described. This application is made in compliance with County Ordinance No. 549. '!� Q ` / ----- JOB ADDRESS AND LOCATION----,I .r F ---- ------------------ Phone:00-__��--��a Owner's Name--- �-�'-fCG�- -' ----.�SsNm_��{-�-------------------------------='--------- - - Address ---------- ' �------------------------------ ------------------------:- ; f = Contractor's -----s97- / ,Y�' - ...................... s NamPhone-- - yl�� _ Y Installation will serve: -Residence$d Apartment House Q Commercial [:] Trailer Court [I Motel E3 Other ❑ I - r . i Number of.living units: ---/_lumber of bedrooms __ Number'of baths __ __..Lot size ----------- d •-off Wafer Supply: Public system `Community system E] Private F1 Depth to Water Table ft, i Character of soil to a depfhl�of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' . Hardpan ❑ f Previous Application Made: llf yes,date____________________} No '❑ New Construction: Yes ❑ NoFHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ceisspool permitted if public sewer is available within 200 feet r tic T nk.; Distance from nearest well-----------------Distance from foundation" ___-_---_______-,t_______________.-______-___. No. of compartments----k-----------•---------Size---t------ Liquid,depth-------•-----------------Capacity----------------------- t � s ` Distance from foundaf-on_J.0 aa�li �'�( Number from nearest weILIZDkLL3Distance to nearest lot line_________________ os field: Distance f Length of each line# "l-0--� '__=___.Widtk oftrench.__-_ "-rZ-- ----------- of lines------ ------------ ---------- g f De th of fi material____J��f--:;--Total length--------------------- - Q-------- \ Type of filter-material.. � p r r l^ S a Distance to nearest well_!- �_------Dista "e from .oun t" ion---,lL'?_f__..__.Distance to nearest lot Gne_________ ____ Numbers of pits_____. _ -Lininmat ik_kart------ ize: Diameter__ ,�'��_--"___Depth_._e �-"-- Cesspool: Distance from nearest well__:_____- istance fro oundation_.-_._-- _.______.Lining material-______________________________----- + "` -Liquid Capacity gals. Size: Diameter------=-=-------------------------=--De -------------------'---------------'r-------- _ q P Y Priv Distance from nearest well-___---_____-%-----------�--------------------Distance from nearest building-----'-------------•-----------•---------' ❑ d ------------------------------ e to nearest lot I ne.-' -----"----------------- ` -------- Remodeling and/or repairing (describe):---- ------------ ---4-------------_ - ------- W_ -----. ----------------- ,� _ - -•�L.-asv- --------------------------------------------------- ---------- ____Y_______________________ • ----------------------------------------------- I. -------------------------- 1 hereby certify that I�kave prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I� �! G F• (� Confractor) (Signed)-- �¢' `�= `t- --+-- I,. - x frtle)------------------------------------------------- ------------- BY� --------------- = (Plot plan, showing size of lot, location of system in relafio o�weils- buildin of .,`can be placed on reverse side). j� FOR DEPARTMENT USE ONLY //` APPLICATION ACCEPTED BY_ =------------ DATE----- r -----ax-------------------- REVIEWEDBY-------------------'l)----------- ----------------- --------------- -----------------------------------------------------• DATE,-------- -----------•_---------------------------••------= -------------------------------------------- BUILDING PERMIT ISSUED----------------------------------- ----------------- --------------- DAT Alteration and/or r orn[riendafiions:____-- ----~ _-- - ------------------------------- ---------- --------------- ' ------ Lam` "-------------------------------------•--------------------------- --------------- ------ --------------------- ------------- ------------------- --------------------------------------------------------------------- --'--- ----------------------•------------------- ---------------------------------------------- ---•------- FINAL INSPECTION BY: Date �`✓ - -------------- ---------- - f I� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 41h Street Stockton,California Lodi,California Manteca,California Tracy,California 1 69.9 REVISED e-69 F.P.CC.7M 6.6D 1'