17112 (2) - Laserfiche WebLink

Home Browse Search

/ F9R rOFFICE USE: R R J J/J7/_ .ra _ i :� Perm No. - 1/ C` - -'- ----- APPLICATION FOR SANITATION PERMIT ------- ------------------ ---------- - _ - ,. (Corrl�slete=in Duplicate) J t Date Issued--------------- ---------------------------- W -- - ----- ------ _-_-____Y;------------------------ This-Permit Expires 1 Year From Date issued' Application is hereby-made to the San iJoaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in compliance with County Ordinance No. 549. S 2- 0� 4-4-5-:x 3 JOB ADDRESS AND OCAT ON.... -•---- -- ------- �° Owner's Name . '•---•------------------------------------------ ---------- - ----- Phone. ----------- Address----- . .--------- ---- - -- -------------------------------------------------------------•--------------------•------------ -------_------- Contractor's Name �� :A'"�lo � �U -- ---------- ------ - = = - Phone # Installation will serve: 'Residence El Apartment House El ❑ Trailer Courfi ❑ Motel ❑ Oth r i Number of living units: A--- Number of bedrooms _ Number of baths -- Loti size , . --------------------------------•- Water Supply: Public system ❑ Community system ❑ Private 2--bepth to Water Table4�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [-] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----. ------- No New Construction: Yes ®-No ❑ FHA/'VA: Y`6s 9�—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,rte (No septic tank or cesspool permitted-if public sewer is available within 200 feet. ' A � --=--:--- •• Septic Tank: Distance from nearest well__�. __Distance fromlfoundaµionTM-; ---=----Material- r [ No. of compartments- -----------------Size,;q. � � '''I-_W"Liquid depfih______-- �/__- „. -__Capacity/�� ---- Dispo'sal Field: Distance from nearest well__� :._rDistance from foundat n�__�- Distance to nearest lot line__-_�__-_--_- ©/ Width-of trench_---------------------- ="------ Number of lines-----A-----_f_.. - Length of each line__-___-__._�.-_-_-._., De th of filter material_,_ ....---_°_ Total len th__lt�9_________________ Type of filter material _ p ---- F 9 ,J i Seepage Pit: Distance to nearest well-Z, __Distance from. foundation- --- ---.t _...Disfancto nearest lot line-3;;�T------- �. Number of pits--_-�_-_-____. -.Lining material .-Size: Diameter-- --------Depthds- ! �---• t Cesspool: Distance from nearest well-----------------Distance from foundation--------------------.Lining material_ - ------------------------------- gals. 0 Size: __-__-.-______- ._____-__-gals.SEze: Diameter --------- Liquid Capacity---------------------------- - pth------------------- -Privy: Nw Distance from nearestwell---------------- ----------------------------_Distance.from nearest,buildi.hq-----------------------------------------. ❑ Distance to nearest lot lin~e-y------�---,-�-�-�------------------------------- -------------------------- --------------------------- --------------------------------------- Remodelin9 and/or repairing {describe):-----i --------------------•------------- -•---------------- � ----- - , ----------------- ---------------------------------------•-----------------•---------•----------------..----------------------------------- ----- ------------------------------- -•------------------ --•-----------------------------------•-----------------------------------------------------=----- - -------------- 0 1 hereby certify that I have prepared this application and that the work will be done yin accordance with San Joaquin County i ordinances, State'laws, and rules and regulations of the San Joaquin Local Health ✓ District: -----------------�or Contractor) )------- IG - ----------------- - ----------------- ---- / By:------------------------------------------------- ----------------- --------------(Title)! '� -------- ---- -- ------------ , (Plot plan, showing size of lot, location of system i anon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _, APPLICATION ACCEPTED BY-------•-- 7 ------ ------- ------------------------------------ DATE -5;7-- -- ------------- REVIEWEDBY------------------------------------------ -------- ._._.. DATE--------- ---------•-----------•-----------------=- ---------------t--------------------------j--- BUILDING PERMIT ISSUED------------------------------------------------------- ---------------'-----_..�------------------r DATE------.. _ Alterations and/or recommend tions:----______-?:7::/- .. ....---- - ```� ��----- �} / .� - � f ti �� - - � (%� -.. --------------------------- ra• G•'�tC�x-Gc.��,—fr1�LG/r.L'�l-�7d�c.�!�["J�'mafc/Y�PGC•.'4 �f�I'.��'Z_L - t�s --, F ------- Crzcv�v �r `- �v _ ------ Date .FINAL INSPECTION BY..--- - ------------------------------------ SAN w 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 ES 9 REv15EO 13-59 3H 3-'63 F.P.ra.