17091 - Laserfiche WebLink

Home Browse Search

FOR OfJFICE USE: / _t3o APPLICATION FOR SANITATION PERMIT Permit No. (Complete.in Duplicate) _ ... —Date Issued I _ _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance'with County Ordinpince No. 9. JOB ADDRESS A D LOCATION_ _c.�� "" --------------------------------- Owner's Name- -- --_- -- ? . ---- f ---- ----------- - ----•--. .. -- --�---- --- - ---- - - --------- - ------------- ---------Phone---------••----------•---------- Address--- '� `f ----- ---------- -- = --------I---------- ------------- ...-. "r"� .- Contractor's Name-------------------------•-------��A- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I-.Number of bedrooms .� Number of baths ___�___ Lot size "71x � J } Water Supply: Public system .4-:-Community Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam p Clay ❑ Adobe-a--Hardpan ❑ Previous Application Made: IIf yes,date------------------_I No New Construction: Yes .❑ No [?J-�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septi tank or cesspool''permitted if public sewer is available within 200 feet.) Septic nk: ante from nearest well_---------------Distance from foundation---------------____.MateriaL..__.._-____-.-------------_______-..-____-_---. j ? of compartments----------- --------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- Disposa i Id- istance from nearest well_____________ ___Distance from foundation------.-------------Distance to nearest lot line_______-._...._.. ❑ Number of lines--------------f---------------------Length of each line--------?r-Z%--------------Width of trench_. :j__._________..___------------------ %A ..Type of filter material___ ��%e-�_____Depth.of filter material______________________Total length--_-_-__--2-GY_----__-_-...___-__-- t _I Seepagit Distance to nearest well_; �------`D•sstanee_r.o�n foundation_/a_-.__.-*----.Distance to nearest lot line0 'Number of pifs---- Linin material____ _ _-Size: Dia meter__�_�3.:�._'&Depth-----..2J-.-___1_____- Cesspool: Distance-from nearest well---------___-----Distance from foundation--------------------Lining material------------------------ 1771 Size: Diameter. - - - Depth -----;--- -- --------- - ---- ----Liquid Capacity----------------------------gals. + :v Privy: Distance from nearest well______________________-_____________.,_-_._-__Distance from nearest building___._..-_____-----__--__--._---___.___._. ❑ r + to nearest lot line ------------------------------ ----------- Distance ----------------- Remodelingand/or repairing (describe) -- - ---------------------------- ------------------------- -•-----------------------------•---------------------------------------------i------ s --------------------------------------------------°-------------_-----------------------------------•------=------`---------------------_---------------------------- -------------------------------------------- f i - --------------------------------------•-•--•-------------------•---....------------------- - { -----•--------------------------------------:------•------------------.-------------- ----- I hereby certify that I have l repered this a plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul ion of th San .Joaquin Local Health District. _. Owner and/or Contractor) (Signed) x l � r - --------------------------------------------------------------- ---------------------------------- -- -( � rector) By-------------------- 1 -------- ----- --- - --------------- ---------------•---------------------(Title)------ --- --------------------------------- ... --.._.--------- (Plot plan, showing size of.lot. location system in relatio ..to wells., buildings, etc., can be placed on reverse side). FOR RPARTIVIENT USE ONLY APPLICATION ACCEPTED BY---- _._ f --- � �~ ` // DATE = f REVIEWEDBY--- ---------------------------_ ----------------------------_---------------------------- DATE ---------- BUILDING PERMIT ISSUED---- ------- --------- recommendations: -� _ ---------- --- �- DATE A'TE-------`-----�------------`-- ---- -------'- ------------'------- ------- ------- Alterations�d or re ommendations:._.____. - ---------- ------ -----'"--- I ------------------------------------------------------------------------ :--------------------------------- ------ ---------• ----------------------------------- ------.. --------------------- ----------------------- ----------------- -------------------------------------------------- ---------------------------------? ------ FINAL INSPECTION BY----- -------- ------ ---------- -------------- � t _ ------ Date.... /.____: '.___-:-'--------- ------------- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. R 3 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED D-59 3M 3-•63 F.P.CC. ' F