17258 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: w j I { f.3`'----- 7 . .. ��/ y /f-3� APPLICATION FOR SANITATION PERMIT' Permit No. ........................ (Complete in Duplicate) k 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 NP. 549. 7 ----- ------ ------------•----------------------_------------- JOB ADDRESS AN N----------- ' , - w Owner's Name - F/'f - ------------------------ - Phone...............' -� Address f S 1 - - ---- coo { Contractor's Name_____ " ' -- -__' - - - - Phone. ---` s Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 4Motel ❑ Other ❑ s Number of living units-./.__. Number of bedrooms _/__ Number of baths _I__ Lot size ........r ------------------------ Water ---____________________Water Supply: Public system Community system ❑ Private ❑ Depth.to Water Table ft. ft. Character of soil to a depth of 3 feet: Sand E]j: Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayb Adobe Hardpan ❑ Previous Application Made: - (If yes,date----------- ----- No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Tank: Distance from nearest well-----_----------_Distance from foundation_____________'___ Material---______._-_...______. :. ' No. of compartments--,-----------------------Size---------------------------------Liquid depth------------ Capacity.- ...... is,d,, .Field: Distance from nearest well-------------------Distance from foundation---------------------Distance to nearest lot line----------------- Number of lines----------------------------------Length of each line-----------------------------.Width of french----------------------------------- _T r e.of filter material___________________--_ Depth of filter material----------------------- YP PTotal leng+h----------------=------------------------ �j1 t Seepage Pit: pistanee to nearest ,well. _ _ ________..___Distance m ZZ, dation. Q._..___.Distarice to nearest lot line__`-`_'_.___/_._ La r< Number of pits______ ______________Lining materia€ Size: Diameter__„�r-___-._____-..Depth_-___�_S��_-___.________ 1" Cesspool: Distance from nearest well_______________!_Distance from foundation_--__._-________.__ Lining material-.___--..__._-._--_-__.___________- t _-Li uid Capacity gals. Size: Diameter Depth- 4 ; - Privy: Distance-from nearest well--------------------------------------------------- from nearest.building__-_---.-_._______;_____________..____._. % ❑ Distance to nearest lot line______;___- ---- ----------------------------------------------------------------------=-------------------------------------- ---- Remodeling and/or repairing(describe)--------------------------------------------------- ---------------------------=-----•------•------ -------- ---------•--------- k ---------- ------------------------------------ , ----------------------------------------------------- •------•------------- ------------------------------------------- t ____________________________ _____________________________________ _____________ _________________------------------------------_----------__________________________________________________________________________________ I hereby certif #hat 1 have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, Stat a s, and rules and regulati sof the San Joaquin Local Health District. k s i - - � - - , (Signed)-.-----• -:----- v -- - ----- .- Owner and/or Contractor) L (Plot plan, showing.size of.lot, loca ion of system in relation s, buildings,.etc., can be placed on reverse side).. . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY ,--------- r ------------- ------------------------------------------------ DATE---------�1r�_ �C ------------------------ - .. REVIEWEDBY -= :-`----------- -- --------------------- --------` ------•- -------------------------------------- DATE----------------------------- BUILDING PERMIT ISSUED---------------------------------------= i - DATE --------------- ----------------------•- Alterations and/or.recom endations:_L__ ______________________ ___ ___ ------- ---- -- ; - � -- -�� -----------------:---------------------------- = ----------------------------- ------------ ---------------------------------------------- ----------------- -- ----------------------------------.-._.- --•------------------ ------------------------------------ ---------- FINAL INSPECTION BY:..-------- � ----------------------------- Date--------------1-- ---------------------= -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naietton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street " Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3•'63 F.P.Co,