19716 - Laserfiche WebLink

Home Browse Search

... — FOR OFFICE USE� ------�.-v-f- - :-6_r-_.—_S_) _r--__.: APPLICATION FOA' SANITATION PERMIT Permit No. 1�./-11K, (Complete in Duplicate) I -----.--. This Permit ExF fres 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance N S49. iii JOB ADDRESS D LOCATION--____ lc _ -----------. 4 ---- -------- •- -- -- -- - - ---------------------------- Owner's Name ----------- Phoned_'_ _. ---------------------------------------- - Address_ . t - ---------- Contractor's Name • ------- -�--'G� - - ----------------------- ------ Phone!f �, Installation will serve: Residence [a Apartment House ❑ Commercial Trailer Court ,j ❑ ❑ Motel ❑ Other ❑ Number of livingunits: _�_ Number of bedrooms _ __- >�_ Number of baths dZ Lot size --------------------------- Water 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: I (No septic tank or cesspool permitted if pubiic'sewer is available within 200 feet.)--- � # pti Tank: Distance from nearest well-----------------Distance from foundation._._--_------___--_.MateriaL �_-_-.___.______ _- ' --------- No. of compartments--------- ---------------Size----- - ------ -----Liquid depth------------- --------Capacity4 ' pos I ield: Distance from nearest well.--_--_-_-_____Distance from foundation-_-----------------Distance to nearest lot ling_______.____..__. Number of fines - --- -------`Length of each line------------------------------Width of trench------------ Type of filter material--_____-_____-___.-----Depth of filter material-----------------------Total length------------------------------- Seepage Pit: Distance to nearest welIze-Q_-------_Distan m found --_ ation �/� ____r_Distance to nearest lot line may, 7.� ❑t Number of pits___.__._-.--__---Lining material�G.l _ _Size: Diameter._._. __ --N 7 S Cesspool: Distance from nearest well----- ----------'Distance from foundation-_:---------- -----Lining material--------------------------- ______.__ ❑ Size: Diameter--------------------- De ---------•-- + W pth = -----------------------------.-Liquid Capacity- --------------- ---------gals. Privy: Distance from nearest well-------------------------- - --------------___.____,Distarice from nearest building ❑ Distance to nearest lot lire------ ------------ ---------- -----------•--------------------------------=- . . Remodeling and/or repairing (describe):________________________ ---r 1. -------------------------- ------------------------------------------------------- ---------------------------------------------------- ---------------------------------------------- ---- - ------------- --' ------ ------ - --- ---- - -- - - - -- I hereby certify that I have prepared this application and that the work wili•be 'done7i-n accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed) I - -- ------ - - i -----------: : 1,-- #: _ Own and/or Contractor) er r By_. ----- t (Title) (Plot plan, showing size o lot, location of syste in relation to wells, buildings, etc. can be placed on reverse side). t s FOR DEPARTMENT USE ONLY { t APPLICATION ACCEPTED BY-------------- ---------- < ----- �'�.�f--- -- DATE------- y2-` �- ---- ---- -------------------------- 11 REVIEWED BY ----- ----------- ----- ------- - -------------------- r BUILDING PERMIT ISSUED r ------ -- --------------------------- ------ GIATE ------- Alterations and/or �ecommen dafiions:__--__-�-D-- ---z.__Z-_.�---l�-.��------_�- _ - _ _ --•---• - - '-,.-=-��-----f�--;.---•------ -------------------------------------------------------- ------ ---------------------------------------- --------------------------------------------------------- •------ ---- - - - ----------------- ------ ----------- ------•---------- i r PINAL INSPECTION BY_____ ________ ----- A f l //-') F- `(✓ � -- "y'�,.. Date--------- --------------- /._ : F AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California iManteca,California Tracy,California F.P,r-O. i