19917 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------=----------------------------------- 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. ` This application-Fis_made in compliance with County Ordinance No. 549. JOB ADDRESS AN OCATIO 1'1ur7�• - _ r '� �J� ------- Owner's Na a------ � G -------------------------------------------- Phone------------------------------------ Address------- .vZ ----•---` `��_------------- --- -------------•---- ---- -------------------------------------------------------------------------------- Contractor's Name----------C5�.�---.--�----`'s- -{----7 ---- -- - ---•----------•------- --------------- Phone-----_--_---------•----------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms -3--- Number of baths __ Lot size _ ------------------------------ Water ----••----------•- -Water Supply: Public system ❑ Community system ❑ private Depth to Water Table _--_____ ft. I 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: x (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic nk: Distance from nearest well---- Distance from foundation----/a________Material---- --------------- ---- �- - -----------�- �--- '-S_'Liquid depth------- ---------- Capacity__L)_ oj_ _Z No. of compartments-._.-__._�"___--_-.-._Size_�f rf�/Q� o Dispos Field: Distance from nearest well_____ ©_..._Distance from!foundation-----/..19---------Distance to nearest lot line____----.---- . Number of lines.-- _! _---------------Length of each line_VZ� Z-`= - Width of ch -- ----Y____--__--__----- C ---- Type of filter material__- � _-_-__Depth of filter material____- ° Total lenth___-_._�f -----------___________ Yp p �`d 9 Seepage Pit: Distance to nearest well------------------- -Distance from foundation-------------.------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- rn Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material-___--------___---_-_--_- ❑ Size: Diameter------ -------------------------------Depth---------- -----------------------------------------Liquid Capacity---------------------------gals. Privy: Distance-from nearest well--------------------- ---------------------------Distance from nearest building----------------------------------------_. ❑ Distance to nearest lot kne---------------------- ------------------------------------------------------- ----------------- -------------------------------------------- Remodelingand/or repairing (describe)---------------------------------- -------------------------------------------------------------------------------------•-- --------------------•-------- ---------------------------------- - ---------------•--------------------•------------------------------------_1--------------------------------------------:_-_----------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County /. ordinances, State laws rules and regulations of +he San Joaquin Local Health District. �- a .(Signed -- qsyste - - -- ---------------- ---------------------- -------- BY: ------- ��ar and/or Contractor( - -------------- -- (Plo`t plan, showing size of lot, location ofin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 � _- �r,_�,,.� --------------------------------------------------------- DATE_1� ..�-6`----------------------- - APPLICATION ACCEPTED BY_-��''..- `"_--� , - - REVIEWED BY-------------- '- -- ._ _ ----------------- DATE------------------ --------- --------------- ---------------------------------- - BUILDINGPERMIT ISSUED.------------------ --------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------- - - -------------------- -------------------------------------------------------------------------------------------------- ---------- --------------------------------------- ----------------1_7-------- ----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- --------- -----=------------------------ ----------------------------------------------------------------------------------------------------------------- ------------------------------------------- ----------- --------------- --------------------•--- -- - FINAL INSPECTION BY:. 1 !�'- n .r • ------------ Date... _ ----------------------------------- SAN JOAQUIN 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 I ES 9 REVISED 6.59 3M 3-'63 F.P.CO.