17596 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------- -- ------------------------------------- -------- ----------------------- ----------------------- ---------------------------------------------------------__-----.__------------_------_-- APPLICATION FOR SANITATION PERMIT Permit No. .--J� ,� ---------------------------------------------- --------- . (Complete in Duplicate) --------------- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS A LOCATION__._ -- -• -- -- ----------------------- Owner's Na f� c_ G[_ --- --- -- - ------------- ---- ----------------------- - "-------------------------------------- Phone-- --------------------------------- Address -----------------------.---. _ � V Address A --��---------- - �� --------------------------•------.. Contractor's Name--% ` -----L - one ------ Ph ----------------------------------- .40 Installation will serve: Residence [ partmen+ House ❑ Comcial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _-3-- Number of baths __/---- Lot size -/0---62<__-,W_________________________________ Water Supply: Public system [Community system ❑ Private ❑ Depthfto Water Table loft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam 0 Clay Loam p Clay ❑ Adobe E] Hardpan ❑ Previous Application' Made: (If yes,data-------;-----------) No ❑ New Const�tion: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF 'INSTALLATION AND SPECIFICATIONS: r I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) $ Sep ink: Distance from nearest well-----------------Distance from foundation-------------------Material-------------------- -------_---.--_.-.___-__--. No. of compartments-- ------------------ Size Liquid depth Ca�acitY = Dispos Field Distance from nearest weii---"-�_----_Distance from foundation-Zf--------------Distance to nearest lot Number of lines.------- -----_ -----------Length of each line_,t.D_`----------------Width of french----A. �--.-`'--------------•-- Type of filter material._--�c°1G�C p Y 4J. -.---_De th of filter material-/--__________ Total length_-J---p----:---_-----------------_-- Seepage Pit: Distance to nearest well_--------------------Distance from foundation---___------.----_.Distance to nearest lot line------ ------ _ ❑ Nu mber of pits----------------------Lining material------------------.- -Size: Diameter-----------------------Depth--------------------------------- , Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- Size: -._----_- _------ ❑ Size: Diameter------ -------------------------------Depth-------------------------------.---------------------Liquid Capacity-------------------- -----gals. Privy: Distance from,nearest ---------------------------- Distance.from nearest building----------------------------------- ❑ Distance to nearest lot line------ --------------------------------------- --------------------•-- ---------- Remodeling and/or repairing (describe):----------------------------------- ---------•------------•-------------•---------•----------- , i - --------------------------------------- ---- -------------------------•--------------------- ------------------------------------ -------------------------- , ------------------------------------ -------------------------------------------------------- ----------------------------------`------------ -• -•:--------�� ------------------------------------------- 'tion and certify that I have prepared this application and that the wor`,k;will be done in aaco dannce�ith San Joaquin County .�/ ' ordinances, State laws, and rules and regulations of.the- San Joa in Local-Health District. }yy rf I A7 (Signed) ---------(O -etmb4or Contractor) --- --- ,0113 BY:------- -1---------------- ----------- -•------------ ' ---------- -----------------------------------------------------{Ti+le) --------- ------ - - --- ,kk A I {Plot plan, showing size of lot, location oflyiPeern in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- , 14 TR._-_0-.-- - - ----------------------------------------------------------- DATE----- - ------------------------- REVIEWEDBY------------------------------- n---------------- -------------------------------- -- DATE----------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------ DATE------------ Alterations ATE Alterations and/or recommendations------------------------------ a -----•--------------------------------------------------- ------------------------- ---------------------------------------•-------------------•-------------•------------------------------------•--------------=---------- t ------------------------------•----- - -- ----- - ------ ---------------------------------- ---------------------------------------------------------------•------------ --------------------- -- ---------- + r A FINAL INSPECTIONJY�.. v_ Date-----_.---- !-- - --`- r i c-_-•--------------- -•_-F l , SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielten Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 9 REVISED'9.59 3M 3-'63 F.F.CO. 1. g