17338 - Laserfiche WebLink

Home Browse Search

OFFICE USE: W--, --- Permit No. --- -APPLICATION FOR SANITATION PERMIT ---- ------- ----------- ---------- --- (Complete in Duplicate) w �Z?i �' -------- -- - DateIssued �_-- - _ _7 ___---� 'This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and ' all the work herein de�cJnd. This ap -lication.is.made,in compliance.wif County Ordinance No. 549. ��' �8 : . . JOB ADDRESS AND 'LOCATION,---- _---------- ------ --------------- f /V • -C •• p_t__�i � ,�✓ Owner's Name----- ll- ' ' 4• :C �Y- ------------------------------------�--- Phone-. --- r { ------------------•------ ----------------•--------- �^ 'E:- I Contractor's Name.------- ----------------•---------------------------------------------------------- Installation will serve: -Residence [Apartment House ❑ Commercial F] Trailer Court E] .Motel ❑ Other El f Number of living units: I----- Number of bedrooms ./__-_ Number of baths ---/---.Lot size :__________- C :- __---------•--------------- k Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,g Clay g Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No x New Construction: Yes ❑ No FHA/VA: Yes ❑ Nox i TYPE SOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material-------------------------._________--..----.__--- ❑ � No. of compartments------------------------- Size-------------------------- Liquid depth Capacity l Disposal Field: Distance from nearest well_.-_---___".-Disfance from foundation-----------------___Distance to nearest lot line----------------- El Number of lines = ------Length of each line------------ Width of trench - Type of.filter material-______-- -------------Depth of filter material______________________Tota€ .length__________-_____._..________-_____------- Seepage Pit: Distance to nearest well------1�_�-___Distance from fpundation___.��-.i_____-.Distance to nearest lot line-_:-:J �_--. p Number of pits material_ i_-� _- '- r_.Size: Diameter_--_--7— _z0Depth----- rt 64A4 _� a7-=- ---------------- Cesspool: ,,,Distance from nearest well-_-.:.________-Distance from foundation--------------------Lining:material-------------------------------------- ❑ % Size: Diameter-------------- --- -------Depth----------------------------------------------------Liquid Capacity ------------gals. J Privy: Distance from nearest _ __ ________________ __ __- _. -___.-__ ___.__._Distance-f.rom nearest building-_-_____,- _-________-_-..____.._-_.___- ❑ Distance to nearest lot line------------------------------------------------ - - -------------------------------------------------•--- $ Remodeling and/or repairing (describe:--------..e 1'�� --- i •�r�''� `�? --------------------------------------------- s 4--•--•••---------------•---------- ----------- -------- I hereby certify thaf] 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. �r e and/or Contract �i k --------------------- -------------------- a 'T ( 9 )---- ---------- ---- -- Orin r d/o Contractor) B •-------------- - -1 — .� _:_< _---------------------------------------(Title)--------- �`- y---------..._.. .__... (Plot plan, showing size of lot, location.of syste�ii in relation to wells, buildings, etc., can be placed on reverse side). r x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- - ------------------ DATE-------- -�--- /_71 ---------- ------------ REVIEWED BY. -------------------------------- --------------------------------- DATE BUILDINGPERMIT ISSUED--=------------------------------ -------------------------I---------------- -------- DATEt---------------------------:----------- -------------------- Alterations and/or recommendatigns:.______ �----�: -1=�-�-�°1 f < - --------`�- ------------------------------------------------------------------------------------------------ ----------------------_----------______-------_____ t----------------- __ _-_-________--_-_._____.__-________._.-.-_-_..__-_-______.__---_-----.---.----_-____._-_.__-_-_.__ -------------________________________________ ____________5___- .-.-__-_____-_______._----------------------- ----------------------,-------------------.___._--___.____--__-._____-__.____------------------------------------------------------------- ..-. F]NAL7 INSPECTION-BY:^-".---- ---------- Date----- ---- ---.-------1--- ----------- -------T1- ------------------------- NSA --------------------- NSA JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:eiian Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t � Stockton,California Lodi,California Manteca,California Tracy,California I ES 9 REVISED 8-59 3M 3-'63 F.P.E O.