17771 - Laserfiche WebLink

Home Browse Search

• OR OFFICE USE: ---------------- -------------- - APPLICATION FOR SANITATION PERMIT Permit No. ../...77..____ }----- -----------_..-- -- --- - (Complete in Duplicate) - t � - Date Issued --- ------------------------ -- - This Permit Expires.i Year From Date Issued p i Application is hereby made.to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS A 'A-177 LO CATION- Owner's K = •---------------------•-'-------- Owner's Name----- -"""-"'"-►�~ � ---------"------------ ----;-- ---- -~Phone---------------'----- ----••- ----- ----- Address --------------------- --------••--------------------------------------------------------------------------------------------------------------------------------- Contractor's Name-_ - . Phone_______________________ Installation will serve: Residence ElApartment House E] Commercial E] Trailer Court E] Motel ❑ Other I Number of living units: __�__ Number of bedrooms ___ Number of baths Lot size __ - - _______________________________ Water. Supply: Public system .[P- Community system ❑ .Private ❑ Depth to Water Table _ Yft. Character of soillo a depth of 3 feet: . Sand ❑ Gravel ❑ S dy Loam E] Clay Loam [) Clay ❑ Adobe Hardpan El Previous Application Made: (If yes,date_-------___ --------1 No New Construction: Yes [] No [KFHA/VA: Yes ❑ No } TYPE OF INSTALLATION AND SPECIFICATIONS: `(No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septi anki Distance from nearest well_________________Distance from foundation---------------------Material------------------------------------------------- � No. of compartments------------------------ YSize__.-•------------------•-------Liquid depth-------------- -----------Capacity------------- --------- Disp I Pie �� Distance from nearest well-----------------:Distance from foundation--------------------Distance to nearest lot line----------------- Nu'mber of lines----------------------------------Length of each line---"- -------------.Width of trench------------:--------------------- ...Type of filter material------------------------- of filter material------------------------Total length----_-.._-.___-________________----_-__-. Seepage I Distance-to nearest ell_____.�-"""-ry=Distanr�.�{om foundation/j}_.r_-i--------Distance to nearest lot line_'__.._ �- Number of pits----------j------------Lining rhaferial-_-] _6"C,- ___.Size: Diameter.__"tg..__.-.___.Depth__..-0_Lr/--____,.______ Cesspool: Distance from nearest weil________________!Distance from foundation-__._.______-_..__.Lining material---... ________._.____._ _______._. V) Size: Diameter.---- - -------------- -------Depth. -----.----�-�------•--------- - ---- ---------Liquid Capacity-----------------------------gals. Privy: , Distance from nearest well________________ ________ "_-.- A --------_g._----Distance from nearest building------------------------------'-------... ❑ r 7 Distance to nearest lot line ` ' C � a,� - Remodeling and/or repairing (describe):--------------- "-_- --- -------------------------------- ---------------------- R, ------------------------------ -----•---------------------------- - ' a I -------------------'----- ----------------------•------------- --------------------- -----------•-•----------------------------------------------------- 1 here6 certif that I have re ared this a plication and that the work will �-- --_"- -________" __-__- i __San -_" ----_ --------- --------- --------- -- - y y P p pp I-be done in accordance with San Joaquin County ordinances, State laws, and rulns of the San Joaquin,Local Health District. - -------- -------Owner and/or Cot actor (Signed) ` l Title (Plot plan, showing ize oiAoafionofm in relation to wells, buildings, etc., cavi be.placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____....__C6'_�.......--------------------------- DATE 8 =»� ------------------------ REVIEWEDBY----------------------------------------------- ------------------------ -------- --------------------------------------------- DATE----------------- ------------------------------------------ BUILDINGyPERMIT ISSUED------------------------------------=------------•-----------__:----------------------------------I DATE------------------------------- -------------------i dofind/or r commends ion :--------- -------- - ----------- ---------- -- ----- f--------•-""---------- ------------•--•--------._.._-.._----------- -------------------------------- ------.-�-�------ - - ------ " `--------------------------------------------------------------------------------------------------------------------- ------------ --- ------------•------------------ -------------------- -------------------- ------:-----------------------------------------------'-------------------------------------------------------------------------------------------- 1 9 -`------------•----------------- -----------------------------------•------ ------ ---------------------------------- ------------------------------------------- ------------- ------------------------------------ f FINAL INSPECTION BY:.-------- _ ------------------------------------------ —iD -�/. ------------------------------------R -------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 REVISED a-59 3M 3•'b3 F,P.CO. " - .y