17808 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------- APPLIC FOR SANITATION PERMIT Permit No. ........................ 10--------------------------------- VA--------------- ------------------ --------- This omplefe irMuplic*X) Date Issued -------- 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. Z_ JOB ADDRESS AND LOCATION.......3?- j S7- AJ .................................................................................................------------------------.......----•--•-----•--- --------- C-mc?0z Lut"i Owner's Name-----------------_----------- ---------------------------------------------------------- ------ -------------------------------------- Pime.................................... �3 - S' 7-,.-A: L Address............................ /-& c- �F&e- P,L)I X7— .........................................................................................................................----------------------------------------------------- Contractor's Name. 4 av cj_n� ............................ Phone-----.................. -------_---- ----�- will serve: Residence Apartment House E] Commercial E] Trailer Court C] Motel F] Other ❑ Number of living units: ...1--- Number of bedrooms 3--_ Number of baths f_.._. Lot size ---------'53D-K/_S.6........................... Water Supply: Public system 3Z_Community system El Private [] Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand [] Gravel n Sandy Loam 0 Clay Loam [3 Clay [] Adobe 2 Hardpan C] Previous Application Made: (If yes,date-.---.__-___-----) No E] New Construction: Yes F1 No E] FHA/VA: Yes�K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: M AVUSE M011e4 I r) (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----—---------Distance from foundation....la---------Material--- ef-i 0 ci jo -------- - ---------------A------------ 19 No. of compartments---------:?-=_;------Size.........3,x----- Liquid clepth-------------V___ Capacity...... ------9____--- Disposal Field: Distance from nearest well.--.._......Distance from foundation......Ze.......Distance to nearest lot line----::;�7...... Number of lines___.___0 4- %9 --- Length of each line._-7�_��_�.Z�.'�V_iclth of trench-------•--�----------------- Type of filter material-SV- -- Depth of filter material--------j � ---.--.Total length-------------/Cl 6.................... Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------_----Distance to nearest lot line_---__-.___-___-- ..I ❑ ine----------------- 171 Number of pits-.--------------------Lining material_-------------------- Size: Diameter._--__--_-_`.-------Depth_----------------------------__ Cesspool: epth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-_----------------Lining material..._____-_-.__-______-_.--.____--.._ .Y ❑ aterial...----------------------------------- 171 Size: Diameter.---• -----------I----------:----------Depth----..--.---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well______________________ _____________------------Distance from nearest building------------------------------------------ f_1 Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------- -------------------------------------------------------------------------------------------------------------------------------------- ..........I--------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ------------------------------------- ............................ -------- ------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ --- ------------------------ ------------------------------------------------------------------------------------------------------------------------------------I------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. -------------------------------------------------------(Owner and/or Contractor) ------------------------ ----- .................. (Signed), 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 --------------- DATE-----------_ -------------- ----- ----------- REVIEWEDBY-- DATE------------------ ----------------------------------- - - ------------ DATEBUILDIN6 PERM;A§U E111hA--- ....... -1 --- --------------------------- DA ------------------------------------------------------------- ............ ---------- Alteratiols and/or recommendations:___ A ---- - --- .......... ... ....................... ------------ --- -- -------------- - - -- - - ------ .......tnj....... A!��--------- -------- -.,-(------- -04------ -- -- 4_ A:........ .. ............................................................................................i---------- --------------------------------------------- ------ ----------------------- -------------------------- ---- ------------------------------------ ................--------------- -------------------------------- ------------------------------------- ----------------_ . -- ------------------------------------------------- -------------------------------------_---------------------------------------------- FINAL INSPECTION BY:.-- -- - --- --------•---------------- -----*---------------- Date--------1 -------- ---_--------------:-------------- S OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 96 9 REVISED B-59 31A 3-'63 F.F.00.