16042 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------- ----------------------------------------------- Permlt No. / = --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT f d (Complete in Duplicate) Date Issued ---------------- - -- This Permit Expires 1 Year From Date Issued C77U�� --- ------ ------------------------------------ ---- 23 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. x 3'78 GJ , rcC. J7T X{ S77 JOB ADDRESS AND OCATN-- - - - --._ ---- -- -- ------------------------------- Phone-------------------------- ------- Owner's ------Owner s Na+me---------- --- -------- -------- � -- 10 _- ----•---- ------------- -- - ------ -------------- Address-------------------- -- ------------ ---- Contractor's Name------------ -- Phone...-------------•-----•---------••- Installation will serve: Resident Apartment House El Commercial Trailer Court Motel (] Other ❑ Number of living units: . --_ Number of bedrooms _;�--- Number of baths ----I Lot size ----7z90/90-----•-------------•-------- Water Supply: Public system ❑ Community system ❑ Private '4 Depth to Water Table _M7 - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam r] Clay Loam ❑ Clay Adobe❑ Hardpan • -------------------- No New Construction: Yes No ❑ FHA/VA: Yes ❑ No Previous Application Made. (If yes,date 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I � (� ; foundation-J(2-_ __:__:Ma.ter al_f___ 1 "-" �---•------ Y 'Septic-Tank: -Distance from nearest well----(G?.__-_-_Distance No. of compartments......-�-----------Size----- 7 C3--x-� Liquid depth--------'-t'. Capacity---- - ---0-----01 (,?J Disposal Field: Distance from nearest weVl... -1 -__Distance from foundation------ to nearest lot li �y •- Len Length of each line_- ----------- of lhien length nth-.-.�_ --------------•- c Number of lines___.___.-___ - g �' � �-_ r'� Total 9 Type of filter material 1 �_-Depth of filter materlal_____�- _.____..__. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------- ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter----------------------Depth------ ------------------------- Cesspool: Distance from nearest well----------------- from foundation-------------_-.--.Lining material Size: Diameter ------ ----Depth--- ----------------------Liquid Capacity--- ------------------------gals . _ - -� -� "' ^^^ "F ` - Distance from nearesf'bulcJin Privy: Distance from nearest well----------------------~�-- -- ------- -9 - ❑ Distance to nearest loft line-- ---------------- - --------------------------•------------------------------- y Remodeling and/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 rule£'and regulations of the San Joaquin Local Health District. ----------------(Owner and/or Contractor ----------- St ned _ ---- ------------ ------------------------------------------------(Tit1 {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 APPLICATIONACCEPTED BY------------------- --------------------------------- -- ---------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY---------------------------------------------------------- -- ------ ------ --------------------- DATE BUILDING PERMIT ISSUED DATE-- Alterations and/or recommendations:------------------ ------- ------------ ----------------------------•------------•--•-----------------------#------------- --- ---------------------------------------- ---- ----------•------------- FINAL INSPECTION BY-------------------- -- --------- !/ Date ---------------------------------V SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'69 F.P.CO. -��