17181 - Laserfiche WebLink

Home Browse Search

,4, FFICE USE: V ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- - - ------------------ ------- (Complete in Duplicate) ----------------------4-lv-10---------------------- 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. 49. JOB ADDRESS LOCATION............ ...........................---------------------------------- Owner's Name. . . . .. ......... - may .. .................------------------------ ------------------------------------- Phone.................................... Address.............. - ----------- ---------- -----------------------------------------------------------------------------------------------------------------------------*....... Contractor's Name------------ ------ - ------------------------------------------------------------------------------------ Phone................................... Installation will serve: Residence ? Apartment House [] Commercial [-] Trailer Court E] Motel E] Other E] Number of living units: ---1_ Number of bedrooms A_-- Number of baths -Z- Lot size ____________________________ Water Supply: Public system N--Community system E] Private 0 Depth to Water Table464—ft. Character of soil to a depth of 3 feet: Sand F] Gravel F] Sandy Loam 0 Clay Loam F] Clay E] Adobe 03--Mardpan C] Previous Application Made: (If yes,date----------—-------) No @L--New Construction: Yes [:] No P--FHA/VA: Yes E] No 0.' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic/Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- ,MVI a '411* No. of compartments--------------------------Size--------------------------------Liquid depth-------•-------- ---------Capacity----------------------- Disposal --------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_:_______________ �7 Number of lines____________________________.___Length of each line------------------------------Width of trench----------------------------------- 'eType of filter material_________________________Depth of filter material--- ----------------- Total length_________________:______________________-_ Seepage ength------------------------------------------ Seepage Pit: Distance to nearest well-------:7!-"--------Distance from foundation---- ........Distance to nearest lot line--!R---------- --11/---- - 111 4 -r Number of pits_-___.--_________Lining material_ Size: Diameter-- ----- ------. Depth-,Z0_; Distance from nearest well-----------------Distance from foundation-------------------.1-ining material__________________--____-__-_________ s ❑ Size: aterial------------------------------------- Size: Diameter--------------------------------------Depth------------------------------------ --------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-------------------------- - ------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------- .................I-------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------V--------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, andjules and regulations of the San Joaquin Local Health District. (Signed)------------------- . -40, ..... ae-,o�--------- - --------------- --------- --- ----- -------------- ----- ------------------(G�Y�I�r Contractor) By:-------------------------------------------------------------------- ------------------- (Title)-esw-AZ04—- ---- ------------ (Plot plan, showing size of lot, location of system . relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------------------- -------------------------------------------- DATE-3--..'50-:--- ------------------------------ REVIEWEDBY-------------------------------------------------------------------- ------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED........................................................ ................ .... --------- DATE--------------------------------.------------------------ mak_Alterations and/or recommendations:-.-5-,.'aO.�.-(D-j__-_-__-1s` __-- -I A�-----—---------S.. agpq-------- . .............. ----------------------------------------- -------------------------------------------------------------------------------------------------------C.L-v ----------I--------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------7--------------------- ------------------------r----------------------------------------------------------- FINAL INSPECTION BY:----- ------4. ..... ---- ------ ------------------------------------------------------------------------------------------------------------------------------------------------ - Date.... --------------------------------- SAN ------------ SAN JOAQUIN 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 ES 9 REVISED 5-59 3M 3-'63 F.P.00.