16311 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I J � - � APPLICATION FOR SANITATION PERMIT Permit NO. -------------- .•`�� /- - (Complete in Duplicate) bate 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 Or �e nce-No. 549. � o -7 /U.. JOB ADDRESS AND LOCATION_�i*Y- , --�17�-`-�-e7- ---�54 /d _.-----------------------..--•-----------• �-- � - o dNs----zoo--rtes' - .�j II � ------------------- Phone----•--------- F Owner's Name-____-- � -- --- Address +��► /•-- � ••----------•-------•••--------------------- --------------------•----•-----•------••--------------•--- Contractor's Name--•------- � •-y �' .f� Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms -- - Number of laths _ __ Lot size + '-` - ----------------------- 1 Water Supply: Public system ❑ Community system ❑ Private j-1Depth'+o Water Table -! tt Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑ Adobe V__1Tardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes PR"'No ❑ FHA/VA: Yes [ � No ❑ TYPE: OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public or sewer is available within 200 feet.) Septic Tank: Distance from nearestw i---- Distance from foundation__. _ Ile No. of compartments--1------------------SizetF �,� Liquid depth---� ----------------_Capatity �> -_-_-- Disposal Field: Distance from neareyst well--,�1*.-_._Distance from foundation__/e_--______.Distance to nearest lot line_ta�__/ __-___- O 1 (�/ Number'of lines-----1 L------- ----- ---------Length of each hne__�� -__-- �! Width of trench -- ----------------------------- Type of filter material_, P�1�_Depth of filter material--- --------------Total length__f �__________________________ Seepage Pit: Distance to nearest�well AW----------Distance from foundation---�#Zoe......... ......... ------- 'Number. --- Depth_�tst .�--- Cesspool- Distance from nearest well-----------------Distance from foundation-----------1-----_Lining material--- _ ----'____.____-_-_-_.____.- ❑. ..,.,�``- � Size: Qiameter------ ----------------- -_Depth--------------------------- --------t{------Liquid Capacity ------------------ gals'. _ __._--_--______Distance.from nearest building -Privy: Distance from•nearest well--------------------------------- 9 El Distance to nearest lot line------------------------------------------------ I. ,r ' Remodeling and/or repairing (describe)----- - � GQ/ II -------------------------------•------------- --------------------------------------•-------------------------- ;I ----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- r ------------------------=-----------=-----�=------------------- -- ----- -=° __ 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 +he San Joaquin Local Health District. -.._.--_ andVor Contractor) {Signed)---------- -------- --- ---- -- ------------- --------------------- ell --------------------------------------- -- ----------- (Title)_ _ -. (Plot plan, showing s00, ize of lot, location of system '7/ ation to wells, buildings, etc., can be p aced on reverse side). FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED ______ ____ ____ ____ ` -- --- -- ----- --- ----------------- DATE--�- ---- =--- ------------------------- i _ _ REVIEWEDBY---------------------------------------- -------------- -- --------------- -------- -------------- . DATE BUILDINGPERMIT ISSUED----------- -------- ,-- ---- -- ------- E-------------------------------------------------------------- ---------------------------------------------------------------- Alterations and/or recommendations:__/`i'- - ------ - ---- -r i i. ------------------------------------------------------ -------------------------------------------- ------------------ •-- •---------------- --------- -•------------------------------------------------------------------- c FINAL INSPECTI BY.... date SAN JOAQUI LOCAL HEALTH DISTRICT 1601 E.Hazelton Avg. 300 West Oak Street 124 Sycamore Street ,2iD5 West 9th Street 5lotktan,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.CC. -+ 4 W