16119 - Laserfiche WebLink

Home Browse Search

FOR,OFFICE USE: -- -------- ------------------------- Permit No. ..:------- q ------------------------------------ -------------------- APPLICATION FORSANITATION PERMIT 6:e---------------- (Complete in Duplicate) ________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued ..�<'�1_.._.4- 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 Ordin ce No. 549. JOB ADDRESS AND LO ION `/ �� `'� F-•---•... --_.... t•-----•••--•••-----••---------•.........•------•--•-- Owner's Name-•--- .... -------------- - --------------- Phone. Address - ------------ Contractor's Name �-- Phone Installation will serve: Residence [g--Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms ..0. Number of baths __f-__ Lot size .1.4_Q__.� ..o .S`................... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table $/__.40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: (If yes,date---------------_----) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ \� TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (n O;titn 6: Distance from nearest well-----------------Distance from foundation_-._._._.__-_--__-_.Material_-__-__-_-_____.-_-__-_---_-______-_-.------___-. No. of compartments-------------------• _--Size-------------------------------Liquid depth-------------- -----------Capacity---------------------- Disposal Field: Distance from nearest wel?, 144t Distance from foundation.,/1-Q........Distance to nearest lot Number of lines________________ ___ _ Len th of each line.__._.____._p' .D_��------Width of trench_____ y_'� . -•------- t Type of filter materia._.. _�Cl� th of filter material___./._______..Total length____.____..-_.._____ Q_�_..____ Seepage Pit: Distance to nearest well-------.-Distant m fo ndation-_�n-.#__....Distancg�to nearest lot line---a_�-.0 Number of pits_._._---/_-_____Lining material./ G!-C- _Size: Diameter-_-- — -- __Depth___.. __ .'._._:_ Cesspool: Distance from nearest well________________Distancefffff from foundation--------------------Lining material------------------------..._.-_.---_ ❑ Size: Diameter----- --------------------------------Depth.---------------------------------- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------___Distance from nearest building.__._-_--._--_---_._-__________._..--_---. ❑ Distance to nearest lot line------------------------------------------ -----•------------•--------------------------------------------------------••-----------•-------- Remodelingand/or repairing (describe):------ -------- ------------------------------------------------------------------------------------------ .........------------A..................... --------------------------------------------------------------•----------------------------------------------------------------------------------------------- -------------------------------------------------------------- ------------- ---------------------------------------- -----------------------•---------------------------- ------------------------------------------------------------------------------------------ I hereby rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S a s, and rail and regul s of an aquin Loc Health District. wrier and/or Contractor (Signed)---_------ By: ---------- ------------------ ` ; � ' "='= ( ) B :.....-•-•• --------------------------------------------------------------------------------- (rifle)--- --- --- -- (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. APPLICATION ACCEPTED BY -Go'-- -- DATE- 7= tl� `3 REVIEWEDBY----------------------------------------------------------- ------------------•---------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations an /or recommendations:.. _.�_ ________________-______.___._____.__-.-_---_-__-_____-___. �� •--- ------------------------------------------------------------------------------------------- ------------------------------------------------------------- --------------------------------------- ------ ---_--- FINAL INSPECTION BY:-------_EI-1i --------------------------- Date------- .--------------------------------.-.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.