16669 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: f ---------------------- ------------------------- --- --- ------------------------------------------------------- ---------------------_.----__.._-______..._-____ -- APPLICATION FOR SANITATION PERMIT Permit No. --------------- ----- ------ ---- --- (Complete in Duplicate) - / Date issued ------------------------ --- ---- - -- --------- - 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, j This application is made in compliance with County Ordinance No. 549. IWA)r.-OSI l7 0.-07 Lpp I } JOB RE� AD -AND LOCATION. �L�_� r l3 N Owner's Nam � ? -c•,cc� C. .. Phone----•------------------------------• a Addressf �v-7 ----- --- --------------------------••-- -------------------------------- j . - ---------------- -- -- --- Contractor's Name a '"'" Phone Installation will serve: . Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ jNumber of living units: I____ Number of bedrooms __y Number of baths 4___ Lot size __________________________________________.____._______.__.- Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date----------..--------) No ❑' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: ^ ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material-.__-_-._______.______._-_-__________-_._--._ . ❑ No. of compartments :Size --------------------------Liquid depth--------------------------Capacity----------------------- -- a Dispo Field: Distance from nearest well_--_•��_..._.Distance from foundation___<<o______--.Distance to nearest lot line____s-- Number of lines------------ _____Length of each line__________ � � --/ �------ - -- Width of trench---�---------------------------- X4 -- - ------------ �o G <. ti; Type of filter material__- _s ,__-_-__:Depth of filter material------- Total length________________________________________ Seeps Pit: Distance to nearest well----1Qd__------- -Distance fr_gm foundation___1a-,�_.___.Distance to nearest lot �- 5_�_____ - Number of pits--------f.________-Lining material_ .___..Size: Diameter_______ ---.-___Depth__ Z—'g-- __________ ___- Cesspool: Distance from,nearest well_________________Distance from foundation...._._..----------.Lining material-------- ------_----.--__________._-_. .❑ Size: Diameter-=------------ r ----.Depth-----------------;----------------------------------Liquid Capacity----------------------------gals. `. Privy: Distance'from,nearest well---_--------------------------------------------Distance from nearest building------------------------------------------ ❑ f. Distance' to nearest lot ---------------- Remodelingand/or repairing{describe) ------------------------------------ ---------------------------------------- -•----------------------------------------------------- ------`---------------------------------------- ---------'--------- ` ---------- --------------- ------------------ - --=--------------- ---------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------- I hereby certify that I have,-prepared this-application and that the work will be done in accordance with San Joaquin County ordinances&Staft aws, and rules nd regulations of the San Joa in Local Health District. (Signed)----- ---- --- ----- -- -- rid or Contractor ( �— / { g • --- -- ---- ------------------ ---------- Title-------------------------------------------- ------------- (Plot pian, showing size of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ --------------- ---------------------------------------- DATE---./ ------------------------- ---- REVIEWED BY-------------------------------------------- DATE---•-------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------- --------- DATE----------- ---------------------------------------------•- Alterations and/or recommendations:--------------------------------- ----------------------------------------------------------------------------------------------------- ----------------- k ---- -----------------------------------------------------------•--------------------------------------- -----------------------------------•---•----------------- •------------- - -------------------------------- - -------------------------------- ------------------ - -------------------- 1 -------------------------------------------------------- ----------------------------------I-------- FI ��. k INSPECTION BY--- - --- --- --------- -- --- � -�--- NAL IN r.....�� - ------------- SAN --- _t SAN JOAQUIN LOCAL HEALTH DISTRICT i t 1601 E.Hazelton Ave. 300 West Oak Streett } 1/ 124 Sycamore Street ( 205 West 9th Street .C,fl Stockton,California Lodi,California Manfeca,iCalifornia Tracy,California - ES 9 REVISED B-59 3M 3-'63 F.P.CG. 3 f 4