19477 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: y �� f _ ------ ----- ---- ----- --- Permit No. .. _.... ---------- ----------------------------------------- --`------ APPLICATION FOR SANITATION PERMIT ------------- --------------------------------- --------------------- ---- - r,___ ------ (Complete.in Duplicate) Date Issued ----- 6.__� S __ _ 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 wit o nt Ordinepce No. S49. . rD aL�CATION Y `� Phone--------JOB ADDRESS AN - -------- Owner's Name------ ----- •--------Address--- - -------------•--- Phone----------- --- ----••----------- < Contractor's Name---------------- •- - ------------ Installation will servAResidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t �7 Number of bedroom ___-_- Number of baths ---____ Lot size ---------/__A—r-----•-----•----------------=--•------- Number of living units: iC �J� Water Supply: Publiclsystem ❑ Community system ] Private ❑ Depth to )kater Table Character of soil to a depth of 3 feet: Sand El ❑ Sandy Loam ❑ Clay Loam El Clay Adobe Hardpan ❑ Clay Previous Application Made: (If yes,date----.------:--------) No>L New Construction: Yes No E] FHA/VA: Yes E] No ] f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) Septic Tank: Distance from nearest istance from foundation__. _�: _'�`� �'a ei•�al '_ -- - No. of compartments_____` -"- -------Sizes Liquid depth_ _. _.. Capacity--- ---- Distance fro fou ati Distance to nearest lot line__�d_______- Disposal Field: Distance from near st well. f�- _ d� """-" !t --Length of a I ------------------------------ ;'u ---d Width of n (�y Number of lines 1 9 = �( Total length "- - -1� Type of filter matenal_,5.r Aepth of filter aferial___��______________ g _ Seepage-Pit: Distance to nearest reel!--------------_-------Distance from foundation---------------------Distance to n�`ar st lot lin,----- ❑ Number of pits----------------- ---Lining material----------------------Size: Diameter----------------------Depth----- ----------------=---------- Cesspool: Distance from nearest well______-----------Distance from foundation---------------------Lining.material---------- ._._.____________-____��5, ❑ Size: Diameter--------------------------------------Depth------------------------------- -- -----------------Liquid Capacity----------------------------9 --- �F ----_- D�stance from nearest buiidin Privy: Distance from nearest well-_-__-__- ----- - g--'---- ' ❑ Distance to nearest lot line--------------------- ----------------------- ------------ ' f� ----- � f Remodeing and/or repairing 3 - ---- - -- ---------------------------------------------------•------------- ------------------------------- ------------------ ---- --------- - -- - ------------------- ----- - ------------ ------ ------------ - - ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rulesand gulations of the San Joaquin Local Health District. --_-----_-- _---_------- -------(Owner and/or Contractor) {Signe ------- ----------------------�- --- ----------------- i. (Title) ------- --- ---- - -- --- ----- ey:. - -- - - ------------------ --- -- -- (r,t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE__ APPLICATION ACCEPTED BY-------------, ----------------------------------------------------- -------- -------------------------- REVIEWED BY- ---- �__ ATE.- - ---- -----BUILDING PERMIT ISSUED---------•--------- ATE--------------------------------------- --------------------- Alterations and/or recommen ations:_____---_----------------------•-------------------------------------------------- ----- ----------------------- ••----------------- ------ ------- { =��=�iz -��`r -------------------- - - -- -- -- --- FINAL INSPECTION BY:-_-.__.__.._ _-_- . _- -- - - Date ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 ReVI9ED 13.59 3M 3-'63 r.P.CC. t� Y4