17325 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -f -1 A„ --------- ----------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .� -3 -5 -- ------------------------------------------------------- (Complete in Duplicated ' Date Issued_ _ ___ ___��00�4 ____._--_ _._-__-__,. ________________________ __ ___ This PermitEx fires 1 Ysar 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. r _ JOB ADDRESS AN�/L�OCAT ON (' p f, �1 i,1 r - Owner's Name -----`�- �` � �__��_�'� �.------•-------------� f ----------------- ------ Phone__..-------------------------------- Address------- .--------------•- -----Address------- 4------ -1 � 021 =---------------- ------- - --- --------- --- -- ..-..-------------------------------- Contractor's Name---------I J----------------------------------------------------------------------------------------------------- ------------ Phone--------------------------------- Installation will serve: Residers e 0 Apartment House Or Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms .- '- Number of baths --- -- Lot size -------------- -------------- =_,--.----_----_.-.._-_ Wafer Supply: Public system ❑ Community system ❑ Private 0 Depth to'Weter Table ---/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E� New Construction: Yes No ❑ FHA/VA: Yes ❑ No AK IS- TYPE TYPE OF INSTALLATION AND SPECIFICATIONS: '1_r n " -a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearestwelL__�?©_.___Distance fromijoundation-1-.----- ----Material-_t1---------------Z- - ________________ Y-N No. of compartments---- -------Size-l-,_> depth------ --------.-Ca acit Yr�----U�---.---_ Disposal Field: Distance from nearest we1L6-2Q--_-..._Distance from foundation---_ .,5---_-.--.Mance to nearest lot line lo Number of lines----- ---------- Length of each line��.'-r�. 5 Width of trench._ Type of filter material-.-L'C4 .--Depth of filter material_-__1_ _____---.--_Total length----__ _.1:__Q........................ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------.-------Distance to nearest lot line--.-------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------_-.___-.___.___ ❑ Size: Diameter-------- -------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest`building__-._.. --------------------------------- ❑ Distance to nearest lot line----- -----------------------------------------•---------------------------------------------------•---------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------•------------•------------------------------------------------------ --•------I...._.--••-----------------•---------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,_Stafe laws, and rules andregul tions of the San Joaquin Local Health District. (Signed)-- Jril a.-. ------- _Zf V-----------------------------------------------------------------------------------(Owner and/or Contractor) BY:------4 11�/ =L-:(-1 �-tLC------ --------------- ------------------------------------(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------------------------------ ---- ------------------------------------------------------ DATE------/------------------------------------------------- REVIEWEDBY------------------------------------- --- --- --------------------- ------------------------ ; �� ------ DATE------- ',•�� BUILDINGPERMIT ISSUED---------------------------------- ------------__--- -------------------------- - ----------------- DATE--------------------------------------------- --------------- Alterations and/or recommendations------------- ---------------------------------------------------------------------------------------------------------------------- --------------------------- ----- ------ ----------- -------- ---------------------- --- -----------------------------•---------------------•-------------------------------------------------- ----------------------------------- f ----- FINAL INSPECTION BY------------------ ---------- -------- j�-- -—------ Date.----IA��'-G- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVISED 9-59 ,3M 2-•6a C.P.CD.