22666 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- ------------------- --- t 1 3 0 , �'-�9�67 APPLICATION FOR SANITATION PERMIT Permit No. ------------ --------- ---------------- ------------------------------_---------- (Complete-in Duplicate), ,��.. - - Date Issued PP---_--- - -----------_--- _-_._......._ TFiigs Permit Expires 1 Year From Issued Application is herebymade to the San Joaquin Local Health District fora permit to construct and install the work herein described. I' This application is made in compliance with County Ordinance No. 549. +-art l' JOB ADDRESS AN OCATION. _I17 _ �. ff / 1 1 - Owner's Name----------• � d ---- Phone--------------------------------•--- Address........ j 2? ---- h ------ ----- ------------ --------------•-•---------------•----•------ -------------------------------------•- Contractor's Name----- --- -- --p--------- ----- ---- - --' - 'r' "''" �"�'..`Q ---------•--- Phone------- ---------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___. Number of bedroom_--- Number of baths �Lot size .-_.�-__` x______________________.__ to Water.Supply: Public system ❑ Community system ❑ Private [!f;,0'Depth to Water Table ------ - ft Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam'❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ Previous Application Made: (If yes,date------------- ---- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t . Vt i r Septic T k: Distance from nearest well__._.Sa...__Distance from foundation--.-_ 90_..._....Maferial '► �e.r~............... p G s, No. ofcompartments..._-c�------------Size_ '�s.� .�[ �X_�'r/Liquid depth-_-7 ......Capacity../ Disposal Field: Distance from nearest wO_-_%a___-_-.Distance from foundation___/,0-.-........Distance to nearest lot lines-_-___.-- �/ Number`:of lines----------=2--------------------Length of each line-- ............Width of trench...4;k.--.:--------.-.---------.- Type of filter material-------5R_ .-.--Depth of filter material_-_- Total length--__ ---------------------------- X Seepa Pit: Distance to nearest well------fQp.......Distance from foundation----ftL.---_.-.Distance to nearest lot line--- ` q Number of pits.-- ----.2......-.Lining material----�rf.r...... Size: Diameter---- -_-_------Depth------c.2 ------ v R Cesspool: Distance from nearest well ................Distance from foundation.-.--.-.A--.---- ..Lining material-------------.--------_---.--------_. f ❑ Size: Diameter- -------- ----- ----------------Depth------ --------------------------- ---- `. ------Liquid Capacity. ---------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from- nearest building-_-.--.---.-_-.--.-----_---------.-----.-. ❑ Distance to nearest lot line -------------------------------------------------------------- I Remodeling and/or repairing (describe):__------ _------------------------------------------------------------------------------------- ---------------------------•------------------------------- ----------------- - ------------ ------------------------------------------------------------------------------------- --------------------- -------------------- a - I hereby certify that I have prepared this application and"'thet the work will.6e'.-dond in accordance with San Joaquin County ordinances, State laws, and rules and regulafions of the San Joaquin.,Local Health District. t � �� i. (Signed}------ -- - - ------------- �; ;< '� eF and/or Contractor) f -` ---------- ---- -----------------------•----------------------------- --- BY: ' ------------------(Title)----- --- -.....------....----------------------- -- --------- ---- = - (Plot plan, showing size of lot, location of sy em in relation to wells, buildings, efc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY------- ...... v- = ---------- ------ DATE._(2-_--___'_ --7------------------------------ REVIEWED BY------------------- __ DATE------------------------------------------------------------ f BUILDING PERMIT ISSUED._.. - DATE--------------------------.F - _ __. _ �..�_._---- - .�.. t --- - Alterations and/o>r r'eco mendations: .......-..................... -------------------------•--------- -------------- P ---�� .�►. --------------------------------------G --------�---- ------------ I. FINAL INSPECTION BY:..------ ----•- Date.--------- - S AQU1N LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California z E.H.9 2M 1-67 Vanguard Press