17142 - Laserfiche WebLink

Home Browse Search

1-UK UlHCE USE: ill ------------------------------ -------------------- ----- A Zz3 -&2,0 - --------------------------------------------------11 7� ----- APPLICATION FOR SANITATION PERMIT Permit No. /----------- ---- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby mad -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 Ordinance No. 549. JOB ADDRESS AND LOCATION ----------- ..........4 -_A Owner s Name--------2 -------_o ------ ...I........... ------------------- -------------- ------------------------- ---------- -- Phone_�2� Address - ------------- -- �"9_7----------------------------------- Contractor's Name--------- C -------------------------------------------------------------------- 9,11 --------------------------------------------- P h o a Installation will serve: Resi .'once Apartment House 0 Commercial F] Trailer Court E] Motel ❑ Other ❑ ,___ %mber of baths ---I_ Lot size Number of living unit -A---- Number of bedrooms Z ill -0-_ ----------------------- Wafer Supply: Public sys. e ,IN Community system 0 Private El Depth to Wafer Table 320- ft. Character of soil to a depth f 3 feet: Sand E] Gravel E] Sandy Loam';K Clay Loam E] Clay ❑ Adobe [] Hardpan d ❑ I 5 Previous Application Made: I -ll f yes,date---------__----___-) No PK New Construction: Yes El 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 ro m neare st ' ce well-----------------Distance from foundation----------------- .�f --.Material ❑ No. of co ------------------------ -_Size---------------I-------------- Disposal Field: Distance.) rom nearest well- i ---Liquid depth-------------- ---------- Capacity---------------------- )a_�_-.Disfance from foundation----la-1-------Distance to nearest lot line----47! LA Number -of lines-----------[----------------------Length of each line----------&—a-1------_Width of trench----------- Type of :,lter,miaferial------ ----�. __Depth of filter material-------_-- -------Total length------- Seep�ge Pit: Distance 4.o nearestiwell-----------------------Disfante-from-f L -------------- ------------ Seepage ----- i. I ounclation--------------__.Disfance,to nearest lot line"---__"-_-_.__-._ F1 Number Of pits-----.-----------------Lining material---------- ---------- _Size: Diameter------------- -1 1 . e.� - - ------Dept h'--------------------- ----------- Cesspool: Distance fj:om, ,.nearest well-----------------Distance from'foundation--_---------_,---_--Lining material- j .7. - ----------------------------- ---- El Size- Dia.meter -------------Depth----------------------------------C Liquid Capacify-i-------------------- - -------------- -!-.-gals. �romenlear`nearest well--'------------ Privy: stance e -------------------------------- Distance from nearest building--------I--------------_------------. El Distance to nearest lot line'_`�_: I II ----------------------------------- Remodeling and/or 'repairing escribe):------- •------------------------ - ------I--------------------------------- ---- ------ -------------------------- ----------4----- ------------------------------------------------------------------- --------------------------------------- '------------------------------- I-------------- ---- - -------------------------------------I---------I k�_j , ------------------------------------- I ------- ------------I------------------------------------------------------------------------- -------------- ---------------- ------------------------------------------- --- - ---------------------------------------------------------------------------------------- ----------- ---- I hereby certify'fhAf I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 'State laws, and rules and regulations of the San Joaquin Local Health District. 10 -- -- -- -- -------- (Signed)----------------------- -- ------- Ilf- -----------f ----------- ---------------------------------------------(Owner,and/or Contractor) -------------- By:------------- 1 _ ---- - --------- :-_---------(Ti"-tle)------- - ------------ (Plot plan. s6;II�in`9s1Ze0f �+-Ill Ccafion of system in eltion to wells, buildings, etc.," can"-bye.placed.on reverse side).�'� FOR DEPARTMENTXSE ONLY— APPLICATION ACCEPTED'� --------------------------------- ---------------------------------------- DATE------ REVIEWED BY----------I d "7-_ ----------- ---------------------- ------------ ----------------------------------------------------- -------------------------- DATE _7 BUILDING PERMIT ISSUED----.I!---- -------- --------------------------..................... ---- ------------------------------------------------------------------------------------------- DATE----------------------- Alterations and/or reco tion's: -------------------------------------- ------------------------------------I ------------------------ ---------------------------------------------------------------------- ------1,---------------------*--------- ---- - -------------------------- ---------------------------------------------------------------------------------------------I------I--------------------------- I .. - ----------------- ----------I------------------------------ --------- l; I ----- .... -------------------------------------------------*-----------------------------------------------------_--------- ------------- ------ I -------------------------- ---------- ----------------------1 11 -------- --- ---- ---------- --- ---- -- - --- --------I--------- - ------------ ---------------------------------- ------i--------------------------------- ------------------------.......... ...... ----------- ------- - -- ----- ----- - -- ----------------- ------------------- --------------------------------- ------- F1NAL -------- ------------------- ---------FINAL INSPEC Date 7 �4 ---- -- ---- ---- A 7-_F---- " - ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,.California Lodi,California Manteca,California Tracy,California ItS 9 REVISFO 8-59 3m 3-,63 F.P,d O.