17730 - Laserfiche WebLink

Home Browse Search

OFFICE USE: ;. APPLICATION FOR SANITATION PERMIT Permit No. ..7.7.Z A /----- ------------ {Complete in Duplicate] 7 Date Issued Z/__,-/A/1/ - This Permit Expires_1 Year From Date Issued r 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 N4. 549. JOB ADDRESS AND LOCATION______? - -- -------------- --- ------------------ - - - -- - Owner's Name______. ` t✓ Y -------------------- Phone---------------------------------•-- s- ,�- - ---- ` Address------------- --•-•• ---•-•----- ••---- _�. - Contractor's Name.-•------- _------------------- --------------------------------------- ----------------------- - ------ Phone.............---_--• Installation will serve: Residence [f'"Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livi�g units:,-!-____ Number of bedrooms _3-__ Number of baths .-1___ Lot size __//��_'��___________________________________ [� Water Supply: Public system eommunity system ❑ Private ❑ Depth to Water Table 4�-d ft. Character of soil to a depth of•3'feet: Sand ❑ Gravel.❑ Sandy Loam Ej Clay Loam ❑ Clay ❑ Adobe[2F—Hardpan ❑ Previous Application Mader',,(lf,yes,date."-.--- --------) No.PT_ New Construction: Yes RT"'N o ❑ FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS:- (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Ta Distance from nearest well_.l_.�___Disfance from fou_rjdation_,f__._-"------rtMaterial _ --.---_----- I El, P = �C g p. Capacity `f a "'\ No. of com artments___._.______________Size____ _ _ ________ .__:___Li uid de th_____ ______. Disposal Field: Distance from nearest well----~-...:Distance from foundation___�6-----------Distance to nearest lot line_____ _________ 1�' Number of lines---.,.3_-_______�______________Length of each line__,34__'Q_e_�_• 6'.Width`of frenc�i"2-�"'�__..�_�'--___ Type of filter-maferial_.7o.CA---------Depth of,,filtei material___ __`___Fs-f r W p g- _______ Distance fr G undafibn__ - ----... est lot line_-- ---- W r See a e Pit: 'Distance to neares well__ �' �d__ Distance fo'near - Number of pits------ 3---.Loring .material. ---- _.__•-----Size- D;ameter..... Depth---. '�S - ---------------- r Cesspool: Distance from nearest well------------------Distance from foundation----------------.__.Lining material------.-.__.---_---_._.__-___________ El Size: Diameter---------------- ------------------`_De th--- ---------------------------------Liquid Capacity ------- -----gals. Privy: Distance from nearest welL_____________--------------------------.--------Distance from.nearesfi building------------------------------------------ ElDistance to nearest lot line-------------------------------- - ---------------------------------- ------------------------------------------------ ------------------- 5 t Remodeling and/or repairing (describe,)------------------------------------------ ==----------------------------------------------------------------------------------------•------------------- .. -----------------------"------------------------------------------------••-----------------=--------------•---------------------- ------- ------------------------••--------------- ---- - --------------------------------------- -------------------------------------------------•-------•----•---------------------------•----------•------- ----------------------------------------------------------------- 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, ano rules and regulations of the San Joaquin Local Health District. (Signed)------------ _ ........ ----- E {Owner and/or Contractor) 01 lan,.showin •stze�ot�locatton of system in relation to wells---------------------------- ---------------(Title]__.__.__-_-._...-____..__._.._ .___..-._. _ ------ --------------- (Plot p g y „buildings, etc., can be placed -on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---------------------------------------- REVIEWED ____________________________ REVIEWEDBY----------------------------------------=-- -------- ----------'------------- --------------------------------------- DATE------ --------------------- i3UILDING PERMIT ISSUED---------------------------------- ----------------------------------------------------•--------•--- DATE------------------------------------------------------------ Alterations and/or • iik`5;"•�r1.e_ac.�or"1 m--mLyendatio�n..s.:.-.-__$�''_Z5_ b_C}--- . - - -- - ----c ---•- -----------,- ------------ ---------------- ------------ - 1 , `--{-_-=�`rF-�= b` /� -- FINAL INSPECTION BY:-"_�5v.----- - -- '`-'"----'------------- Date...... _...-- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT o a 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street f Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.R.CD. R 1}