18333 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------- -------------------------- /p- APPLICATION FOR SANITATION PERMIT Permit No. ._,/_.�1...3.-__... --------------------------------------------------------- / U -(Complete in Duplicate) i71 7i 1 ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con trust and install the work herein described. This application is made in com liance with County Ordinance No. 549. /C- J08 ADDRESS AND LOCATION_._ _` _A ,!'`'� -s /Z-- P rz Owner's Name_ _ ' � � y - - ..__ Phone Address ----••-- .._------ . = -----•- -----------•---------------------------------- Contractors Name----- = ate -.- 4 -r91G_. Phone. Installation will serve: Residence [r''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i e� � Number of living units: __/-_ Number of bedrooms _„d.- Number of baths -------- Lot size -------------------- ------------------------ ; Water Supply: Public system C3Community system [-I Private Depth to Water Table________ ft. x Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made. (if yes,date__---------_--------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.} s Septic ank: Distance from nearest well--- t�-_-----Distance from foundation---j _____-___-.Material------ --------- ----------- No. o€ compartments—'_!A-.____._.----- Size3. I" ___X-_rS-._'Liquid depth___.____�.---._------- Capacit Disposa Field: Distance from nearest well--- g?_�_---Distance from foundation-----10........Distance to nearest lot line.__,'.__.. Number of lines---------------/-----------------!Length of each line----1Qgi_,'-----------Width of trench__'''AZ------------------------ " 1 Type of filter material__� _ ____'Depth of filter material___ `fg_r�_____Total length___-____f_C'49__ ___________________ Distance to nearest well______/jO__._1_Distance from foundation_:_Jt'______.---Distance to riearest lot Ime__.*g_ __-_-. s. �/ I ❑ Number of pits------- material-- r'1�.:----.-':Size: biarele+�- .,✓ ----- Depth----- -------------------------- Cesspool: Distance from nearest well-----------------Distanceefrom foundation----------------.-_.Lining material---.--------------------------------- ro F1Size: Diameter:-..-'=-------`---—- —----=_-`-__Depth---------------------------=-----------------------Liquid Capacity----------------------------gals. 5 t Privy-:' '44Disfance from nearest well___�__:.____________________________________Distance from nearest building----------------------------------------_. Distance to r�earesf lot line_.-____________________._ ❑ � r---- � �� ----------------------------------- -•------- ------- ---------------------- -----.___..---- ---- �. Remodeling -------� -----^ `-� ------------------Za � ',rj-----------------------------------•--•------------ f -------------• .. Z -- --------------------------------------------------------------•--------------------- .....-......----------•--------. ---------------•--------------------------------------------•------------------------------ � 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County s_•ordinances, State•la and rules and regulations of the San Joaquin Local Health District, (Signed) ---a- = -------------------<=---- -- ------- --s ------------ ..... --------------------------------------------------------------------� nd/or Contractor) Iv _ I �- - -, By:----- - — (Title}-------------------- ------------ - -- -�~-- - ,� ...,�` (Plotiplan, showing size of'Iot;-_loca#ion of syste to relation t ells, buildings, etc., can be placed on reverse side). �. s _ 4 FOR DEPARTMENT USE ONLY 'APPLICATION ACCEPTED BY--- - __ __ _--_I r _________________________________________ DATE-_-�� -fir - �'_ ----------------- ------------------- -------------------------------------------------- REVIEWEDBY----------------------------------------- --- -------------------------------------------------------------------------------- DATE----------------------------------------------------------- ,BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- -----------••-------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------- ----------------- ------------------------------------_ -------------------------------------------------------•------------------------------------------------------------------------------------ ---------------- ----- ----------------------------------------------------- FINAL INSPECTION BY:.. .... .. .. . ..........._ ..................... Date__ .'_/j._' ._ _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISCO B-S9 3M 3-'63 F.P.CO. J