17611 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------- _/_ ___. APPLICATION FOR SANITATION PERMIT. Permit No. ._.l 7�..1.�.__... -------------------- ------ - ------ (Complete in Duplicate) {� 3u- -------_----------_______________________.�___..___.-__ � This Permit Expires 1 Year From Date Issued Date Issued -------------------- 1 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 No. 549. JOB ADDRESS AND OCATION____ y� / ----------- �. /- /` Phone------------------------------------ Owner's Name '� � Gr __... ee {_7` � ' Address----------------- ------------ ` ( { ' ------------------------•------------------------ Contractor's Name - /--at.__Tri__- --------------- Phone.... ---------------- --- ------Installation will serve: Residence ©�partment House, Commercial ❑ Trailer Court El Motel E] Other ❑ Number of living units:.____/_JNumber of bedrooms_ 1 .:3�_____._ ._._. . ____,Number of baths._ _...-. Lot size ._- __ _.__ ��______�__._ Water Supply: Public system ❑ Community system ❑� Privafe g- 5epth to Water Table 1 C0_ ft. Character of soil to a depth of 3 feet: . Sand ❑ Gravel-❑ Sand Loam ❑ Clay Loam ElC ay E] Adobe ardpan E]Previous Application Made: (If yes,date--------------------I No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic T Distance from nearest well____' -------Distance from foundation.O....___.__`Material_S.r_L'_ _�1_ ._.____.__. No. of compartments__. f______________Size__- __ �_-___'Liquid depth__- � _�-_.-____Capacity___ /`z7-_ ___ Disposal ield: Distance from nearest well......- Distance from foundation----Z:o_�._.Distance to nearest lot line.S.-- Number of lines-- -__-�- --- ---------- -----Length of each line__________ _ (� Width of trench----- __ J _ ,Type of filter material___4� _1 ellx_k< pth of filter material____- -- Total length-------��1_�___________________________ U1 See pa Pit: Distance to nearest well._="_- ____Distance f. m f undation-- G'----_____.Distance to nearest lot line__r�__-_-_-_ -__ Number of pits._._______________Lining maferiaL_ Cf- _Size: Diameter_ _1_____.Depth_,•.- N L Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------- ElSize: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity---------------------------gals. r--- - Pnvy:-.. Distance from-nearest well____________________________�� -------------=-Distance---rom nearest--building ❑ Distance to nearest lot line----------------------------- ..__ , . } Remodeling and/or repairing (describe):------- 1 IVF NO - -- I hereby certify -that Ihave----re�Ia 9 this-�----licatio ---------------------------------.------------.:- ------------------------------------------------------ - y y p p pp n and that the work will be done in accordance with San Joaquin County ordinances, State laws, a r es and r e u tw ��f the San Joaquin Local Health District. (Signed)----- -------- ---- - -------------------------------------------------------- -------.(Owner and/or Contractor) By:------------------------- - •�<H---- -- • ----------------------- --- --- (Title) ----- --- --- - - _-------------- (Plot plan, showing size of t, 1 cation of system in.relation to wells;rbuildings, etc., can be placed on reverse side): N, ly ' FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY-------------- - v�--------------------------------------- DATE---------- h" 3 - -----=------------------ -------- ---------- -------- -------------------- REVIEWED BY----------------------------------------- e _._:- _- ------.---------- ._ _ _ `"'__ DATE-____-- - - - - -- -- -------------- -------------------------------- ------------------ --------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- _ ----- -------- DATE---- Alterations and/or recommendations:_b� - - ---------------------------- ----•=--------.� 4 - -V— _ S -------------------------------------------------------------- --------------------------------- --------------------------------------------- --------------•---------------------------•------------------------=---------- ---------- ----------------------•---------------------.... -------------- ---- ------- ..-------------------------------------------------------------------------------------------------------------------------- R - --• -----------------'----------'----------------------•_--=----------------------------------------------•--------------------------------- --------=----------•---- --- -------------------------------- --- FINAL INSPECTION BY----- ------- - - ----------------- ------- --•---------- Date--.-------- --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 6,61 E.Haxallon Aro. 300 Wesf Oak Street °5 24 Sycamore Street 205 West 9Th Street r 1 Lodi,California ; Manteca;California Tracy, California 5roaktori,.Gtilifornia .. -- y ES 9 REVISED B-59 3M 3-•63 f.P.CO. i