16066 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------__----------- ------- tr ____________________________ __ ____________________ APPLICATION FOR SANITATION PERMIT Permit No. .....1.�� :. . ---------------------- (Complete in Duplicate) " 1- - -- Date Issued ....................... --------------------------------------------------------- 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 Ordinance No. 549. ( -�, 'JOB ADDRESS AND L CATION _L. ------------ ff 7 � --------/-----•----•----... Phon c _6_ ..6_ .. S Owners Name--------- ------------------• ----...�---------- ---------------------------- --- ------------------------- i Address............................................... ------ ------------------------------------------------------------------------------------------------_-----•--------••--------------- Contractor's Name ------------------------------------------------------•-----------------------•-------- Phone................................... will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._. __ Number of bedrooms -_dumber of baths .1----- Lot size .................. Water Supply: Public system ❑ Community system ❑ Private)< Depth To Water Table 6.___7t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----�r7 — ----) No� New Construction: Yes ❑ No ❑ FHA/T: Yes ❑ -' No 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__�r–�_.._.Distance from foundation-----JO-------Material.................................... ......... No. of compartments-------------;?=------Size.... X�[ x Liquid depth___ _Capacity..... � Disposal Field: Distance from nearest well_..-.` U.. Distane fr to�dation._....I=?_.....Distce to nearest lot line..... �.. Number of lines............... 20 ..– _.nn_Length of each line---------- ............Width of trench.:_....._2�0---_-___---- Type of filter material.L -Depth of filter material---------1 ------Total length--------------------•----f - ----- 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-----------------------------------------------N-,-,-Liquid Capacity---------------------------gals. Privy: Distance from nearest well ----_-__-_--___------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line---------------------------------- ---------------------------------•-------- ................................................. Remodeling and/or repairing (describe):---- -l _-. ----------- > --_-----f ----__ ....../1V5Tt _.......r.R.x. -•-•-----•-•-•••-•---•-•-•-•--,-------•---------------------------------------------------------------------------------------------------------•--------------------------•--•----•------------------------------------ 0 ------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statv laws, and rule"reiull0iqns nod of t e San Joaquin Local Health District. (SicSt nod -------- --. ) (Owner end/or Contractor) By:•--••--•--------------------------------------- -------------•---------------------------------------------------------- -------(Title)------ .-.--------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.;edri•be placed on reverse side). FOR DEPARTMENT USE ONLY 9m APPLICATION ACCEPTED BY d {� -------------------------------------- DATE --��.3 REVIEWEDBY-----------'------------------------------------ --------•------------------------------•---- DATE............................................................ BUILDINGPERMIT laWED.--......................................................–...................................... DATE......................I...................................... Alterations and/or recommendations-.--,.... j -- ------------ •--- -- ---------------------------------------- -------------------- -----•--------•---------------••-------------------------------. --- ------------------------------------- _..------------- --------- ------ ----------------- -- -�" —�� tE't� R �_ .G�. --- ------------- ----- ------ ---------------------------------------------------------------- ------------------------- ------------------------ ----- --- �R FINAL IN TION B 7 - - ---=`-- Date-------------- .. ---------------------------------------- SAN __----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS