16171 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ -611-71 i�- Hca--- APPLICATION FOR SANITATION PERMIT Permit No. .__ .__ -=- -- (Complete in Duplicate) Date Issued _...IZI -:3 ----------------------________----------------------------- 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 County Ordinance No. 549. JOB ADDRESS AND CATION--compliance/ --- ------------ ----------------------------------------------------------- Owner's Name--- .. •--•-----•-•-••-•-...... ---- ------------ -------------------------- Phone.................................... Address------------------------------- - - - --------------•---------------------------------. ...... Contractor's Name__--- _. ___.________.............. Phoner.' ____ ( °__-- -----•-•--•---------•------•------•----------------------------- Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms &eNumber of baths _ _._ Lot size ._/ X--- ------------------------------------ Water --__----•-_-_- -__-_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 4( __ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand oam Clay Loam 7 Adobe Hard an P ❑ ❑ ❑ Y ❑ Y ❑ P ❑ Previous Application Made: (if yes date___________________) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No j]--.Ns, , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publics is available within 200 feet.) Septic nk: Distance from nearest well_.______.__Distance from foundation---1.�--------Materia&W ----__----------------�__-___-. No. of compartments_-_-____Z/_-_----_-Size.....�,K __.__.Liquid depth-_--017%�- Capacity....�- Disposal field: Distance -from nearest well. __.________.Distance from foundation./4-----------Distance to nearest lot line---4._ ___.. Number of lines--------- ,1<------------------Length of each line_.____ _ ------------Width of trench___ �� Type of filter material.._ __ T � yp �;�x_y_°G1Depth of filter material_______�dp_j!__Total length---------_ __tl.:_.---___________________ Seepa Pit- Distance to nearest well-----,--------Distance from foundation__,,f__ll....... Distance to nearest lot line.t5------------ Number of pits-------)-------------Lining materiaSize: Diameter_„�3'---I-------Dept ______________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material__--_-_____--_____-____-_--___-----. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------•------------------Distance from nearest building-__-__-__--_______-_____--_:-._______-_.-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------•-------------------•---------------------------------- Remodeling and/or repairing (describe):---.----- , ---------- .e ---- -------- _________________________________ �'~..--- ---------------------------------------------- --------------------------------------------------------------------------------- ............. -------------------------------- ... ------------------------------------------------------------------------ ----------------------------------------------------------------•---------------------•----------------------------------------------------------------------------------------------------------------------------- I hereby certify th ve prepar. is pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd les and gula ' the San Joaquin Local Health District. (Signed)----- --- (? -----•------ ---------------------------,---- ---------- ------------------------ (Owner and/or Contractor) BY� ----- (rtle) ------ -- ---...------- -------------- ----- -------------------- (Plot plan, showing size of o , ocation of system in relation to we uildings, etc., can be placed on reverse sid . FOR EPARTMENT SE ONLY APPLICATION ACCEPTED 6 =_,•� DATE 3------------------------ REVIEWED BY-------------------------------- --------------------------- ------------------------ ------ ---------- ------ --------------------- DATE------------- - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------- --------------------------------............... Alterations and or recommendat' ns-------------------------------------------------------------- -------------------------- a- /U-- ts"-4 �� •-- ------ ........ 11, . �A�Rifhfe'L! 4�Y►..c�hdr[__s/T._LrGtaa'_. -.Ldpt__.- PS.i ,o —is--� FINAL INSPECTION BY:. - ,GAP' 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 8-59 3M 3-'63 F.P.DD.