16786 - Laserfiche WebLink

Home Browse Search

O OFFICE USE Permit No j �_ _-:_-__--- t--3d APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) .: 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 tstall *work herein described. This application is made in compliance with County Ordinance No.,549. JOB ADDRESS AND LOCAT Z/.y -------- --- / Owner's Name-....1?----- - _ . . ................ ----------------------------------------------------- on Address........................ I---------------- ---•-- ----- - •- --- • _••---------------•----------_-----•------•---•-----••-••-_----__---------------•-•--- Contractor's Nam ------- ------ ••----••-•-- •- --------------�---------------------------------•---------------------------•---- Phone _-_C7-_ Installation will serve: Resident/e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units>!-__-_ Number of bedrooms j-_ Number of baths Z. Lot size _ -- --------- --- - ------------------•------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _-.. ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lpam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ P ❑ Previous Application Made: (If yes,date-_ -j NNew Construction:;Yes ❑ NoFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) t, an Distance from nearest well----------- ----Distance from;foundation_--- __-___----_-_.Material_----_--_------------_-----_-_-__-_-_-_---_-_-_-- No. of com artments--- ------------- rSize-______--- -<----------:-_.Liquid depth -._------- ------------Capacity---------------- ------ I?. _ -, _ 0Disposal eld: Distance from nearest well/e� - Distance from foundation_�_�---___-.-Distance to nearest lot�line_vR_Q_46- `� Number of lines________ _ ____ ______________Length of each line_-_- _�-_'_--„r__-Width of trench- s_--..._ T' TypeI � -------------- -------- < of filter material_---� __-_-_Total length_________________q -_-_____-.•_--_--` Seepage Pit: Distance to nearest/sw� ell_ _ r Distance m foundation__, ___.Dista a to nearest lot IineQ�QQ_ Number of pits--- L-----_-.-- -Lining materialQL-1 -__-Size: Diameter_.------------Depth .- _____________ x r Cesspool: Distance,from nearest well-----------------Distance from foundation - _---_- Lining material._ ---- _----_ J ❑ Size- Diameter---------------- -- -- - Depth ------------ -------------- liquid Capacity-_ •----- igals VI Privy: Disfance from nearest well----- .-----------------------------------------------Distance from nearest building----_------------- --------- --------- 171 Distance to nearest lot line---------------------------------------------------------------•------------•------- .--------------------- Remodeling and/or repairing (describe) --- --- ------------- - -----•-------------------------------------------- ------ --- ................--•......................'-••-- ----•--------- ----•------------------•-•-------------------•------•------------------•----------• -------- --- -•-- --- ----- ------------------------------------'•---`--------------------------------------------------------------------------------------------------------------------------------_-__•--------•-------------•------- ------------- 0 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rul s and r ulations of the San Joaquin Local Health District. (Signed) - -------- --------- --- - W. --( w�1er and/or Contractor)--------B • showin--•size of lot (--cats ---------------- * ---- --(Title). - ------- ---- ----------- (Signed) - -- - By: - (Plot plan, g on of system in relation to wells, buildi s etc., can be placed on reverse side).- .w FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY------ --------------------------- -- DATE. ) = �' .,} \ REVIEWEDBY.....------- --- DATE----------------------------u.;===......................... BUILDINGPERMIT ISSUED.................................- ------ ---•• _._ DATE--------------_- --------------- Alterations and/or recomme ations:._.��__5- oA-----1-3 __--i his: .- _ �z----"------- ---- 1 -----------------••- -------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- .................. .................------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---•------=---° . FINAL INSPECTION BY:------Q �------- ---------------------- Date-I--'---(•fl-' A-----------------------------------------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3•'63 F.P.CD.