16608 - Laserfiche WebLink

Home Browse Search

FOR•OFFICE USE: - ______________ APPLICATION FOR SANITATION PERMIT Permit'No. - - (Complete in blipliaate) ----------- - -- This Permit Ex ires ] 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. h This application is made'in compliance with County Ordinance No. 549. I i JOB ADDRESS AND LOCAT ON -------- ---------------- ---------- ---- _ _I ---- -- --------- -- ,� Owner's Name--- + Phone Address ,' ' . 0:1 ------------------- Contractor's Name----------------------- rte ----------------- --------------••------------ ------ Phone------------------------ ------- Installation will serve: i Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ �I Number of living units: _�°__ Number of bedrooms _x-.- Number of baths -02-- Lot size ------ i Water Supply: Public.system ❑ Community systemIE], Private Depth to Water Table-5,6- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy�Loam ❑ C1ay!Loam ❑ Clay ❑ Adobe Hardpan 1 .� ❑ Previous Application Made: Ilf yes,date__-________________) No ❑ New Construction:tYes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ ,] Septic Tank: r. Distance from nearest well__�.d.______Distanc;e from foundation__&._CS_._-__.Material__ :---___- -No o€'compartments__"'" ,� J ' - Size 1. Liquid depth �� Capacity--/-�� Dis os I Field: Number l from well--- ------Dis#ante from foundation__.�Q---_----Distance to nearest lot line----S -�---- p �. r r .• y es___ �_____--�y -_,____Length of each line +1-LQQ-/Q_9_/QOJti/idth of french_____-,-2-y _____________ Type.of filter,ma#erial_$,_!1"OC1'___Depth of filter material_____ .. _.. length ' I t �y� ----- - .Total -------------------��Q---------- uJ N Seepage Pit: .Dis#ante to nearest well_-_�... •__-----------Distance from foundation---------------------Distance to nearest lot line......._---------- � ❑ Number of pits----------------------Lining material---- ------=Size: Diameter-----------------...---.Depth--.---------------- Cesspool: D•rstance .from nearest well________ ;_hDistance from foundation___-----------------Lining material------------______________._-_--_.__. ❑ Size: Diameter--=--------------------------------""Dept h----------------------------------------------------Liquid Capacity------------------------ gals. Privy:. Distance from nearest well_____________________ .______________._Distance from nearest building.._______________________-__ ------------- x ❑ Distance to nearest lot line------............ Remodeling and/or repairing c -)---------------------------------------------------------------------- ---------------------•-------------------••---------•---------------•----•----------- -------- ------- «. -..� ...-�. = — - -'-------- ------------ ----- ----- - -•--- -- --- • - -- ------------- --- ----- ---- - - --- ----- I here ce tify that.I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance Stat laws, and rules a d regulations of the San Joaquin Local Health District. Signed) -. ' __________________ _�___.__._._ _k. r---g 8----- . - ----- ---- ------�• ---- ----------------------- ( V Owner and/or Contractor)- -- - ------------------------ Y•----------------------------•------------- -- - ( Title ----- -- -- _ (Plot plan, showing size of,lot, location of iystem in relation-fo ells, buildings, efc., can be placed on reverse side). Via! tr FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------- ------------ --------------- --------- --- --- -- DATE------- //-- llJ---------------------------- REVIEWED BY ---- --- - ----- - DATE._ --------- BU1LQlNG P£RM1T ISSUED ----------I l! ------------ DATE----------------------------------- Alterations and/or recommendations: = - ------------------------------ --- --- ----------------•-----'--------••--------------••--------------------•------------------------ --------- ---------------------------------------- ------------------------------'------------ --------- ---------- -------------------------------------------------------------------- --- . i. -------------I-------------------- ------------•------------------- ----------------------------- ----------------------- -------- ------ ------ --------------------------- ------------------------I—-------------------------------------- ------------- -. - -- -------- ----------- ---- FINAL INSPECTION BY: Date 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 E5 9 REVISED 13-59 3M 3•'63 F.p,CD.