16246 - Laserfiche WebLink

Home Browse Search

OR ;F71USE: 3 '3� l! [� --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...z ..r..� -------------------------------------------------------- (Complete in Duplicate) Date Issued ------ 3 --------------------- ----------.----------____--___.._._ 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 is made in compliance with County Ordinance No. 549. l ?3_(&0 Z� JOB ADDRESS AN LOCATION_______-.•-- --csD_-.--� .aa r ------AOQ-------� -d�---- �f___f Owner's Name sJ-. p I Phone. Address------ ._._..[ a"--'- ------------------------ Contractor's Name - -----------------------------------------•- -•-- --- ----------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms _1,_?Number of baths Lot size _ a. --Zd1----------------------------- Water Supply: Public system ❑ Community system ❑ Private �epth t ater Table 7 ft. Character of soil to a depth of 3 feet: Sand C] Gravel El Sandy Loam Clay Loam ❑ Clay ❑ Adob-e lardpan ❑� Previous Application Made: (If yes,date____________________] No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ -- TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic T nk: Distance from nearest well ---- _�__Distan a from foundation_/(�__________ __Materiai__ ------=------- p� No. of compartments_____.._____-_ .____._.Size___ __ X_ __:___Liquid depth_____-f.f-____.______..Capacity-_.&p __� 'rF r Disposal Field: Distance from nearest well. �?._.-.-----Distance from foundation.M___-----------Distance to nearest lot line.__ _<<_____ C Number of lines____I----------_------------------Length of each line__7R -- -------Width of trench___ '____ Type of filter materiar—RQ(A----------Depth of filter material/$__-----------.---Total length__.Ir>�___ _________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation_______.._________-.Distance to nearest lot line-----------------Q� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_-------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.__._______-_.--_.______________-_ ❑ Size: Diameter--------------------------------------Dept h------------------------------------ ---------------Liquid Capacity----------------------------ga Privy: Distance from nearest well------------------------------------------------Distance from nearest building-_______________--.--___________._--- ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------------ -------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------ --•-------- ----------------------------------------------••------- - -----------------------------------------------------------------------------------------•---------------------------------------•-------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. ----------------- - ------ ----------- ------------------------------------------------------------------------------------------ Owner and/or Contractor By:-------------- -••------- -- -------------- ------------------------- ---------------------------------------(Title)------------------- -- ----------------- ---....--- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.------- _,�1-1---`------- - - "'-- ------------------------------------- DATE-------------------Y ---Z��- -� -------- REVIEWEDBY--------------------------------- --------------------------------------------------------•----------------------- DATE------ ------------•---------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ----------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:-------------- ----------------------------------------------------•-------------------------•----•---------- ------------------------------------------------ ------------------------------------------------------•---------- ---------------------------------------------------•---------------1-- -------------•--------------•- -------------------------------------------------- ----------------------------------------------------------------------------- - ------------------------ ------------------------ --------------------------------- --- -------------- -------------------------------------------------------------------------------------- -- ------------------------- Date-- --- -------- / -G. FINAL INSPECTION BY---------- ---- � ---- / -�� ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California R Manteca,California Tracy,California ES 9 REVISED 8-59 3r+1 3-'63 F.P.D97.