17676 - Laserfiche WebLink

Home Browse Search

PR OFFICE USE; - � ----------------- o-_a4_._ ------------------------.-------_______________---____. APPLICATION FOR SANITATION PERMIT Permit No. __ _ 74__74 (Complete in Duplicate) ----------------------- -- ----- This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION____f --- - ---------------------------------------•------------ Owner's Name = ---------------------------------------- ----------------------------------- ------ Phone----------------------------------- Address ...__.... -------•----.----•--------------------=------•--- ,. c Contractor's Name---- -------•---- � �--------------------------- Phone-----_-------------------------- � Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms .% -_ Number of baths __1___ Lot sizep_x-l- ,-a------------ --------________ , Water Supply: Public system e__Eommunity system ❑ Private ❑ Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay [ Adobe [5--Kardpan ❑ Previous Application Made: (If yes,date____________________} No �ew Construction: Yes ❑ No 9?`FHA/VA: Yes ❑ No 9;--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic aW: " Distance from nearest well_________________Distance from foundation-------------------Material--------------- No. _of compartments---------- ---------------Size___'.------------------- Liquid depth--------------------- Capacity---------------------- Disposalielc� _ Distance from nearest well-------------- .._Distance from foundation________ .. ___________.Distance to nearest lot line___ _-_______--- ❑ (�f Number of lines-----------------------------------Length of each line------------.----------- -----.Width of trench------------------------------------ Type ------------- - ---_-------------Type of filter material-------------------------Depth of filter material---______.____.____Total length________________________________-__-__.' , Seepage Pit: Distance to nearest well___________-----------Distance from foundation__��___________.Dis#ante to nearest lot. line__._________-. --1 { Number of pits------ Lining maferlal._--_11�C_�_____Size. Diameter__33___-_- .; --------Dept h------ �.�----------------- F -,.Cesspool: Distance from nearest well-----------------Distance from foundation.______ --- }__'_..Lining material__..__..____________________________ r ❑ Size: Diameter--------------------------- ---------.-Depth------------------ --- -------- - --------------Liquid Capacity,-.-------------------------- { Privy: _ Distance from nearest wO-------------------------------------------------Distance from nearest building------------------------ ❑0 Distance to nearest lot line--------------------------------- --------- y� Remodeling and/or repairing,(describe)------------------------------------------y ---•-----------------------------------------------------------•-------------------------------------------------•-----------•----------------------------------_----------------------------------------------------------- _______________________________________.___---_________-__-__-_______--_.-----------_----------------------------------------- -----------------------------------------------------------------------------------------____.... ________________________________________________________________________________'_____________________-_,_-________-____---__________._._________________________-______________,m______-__-_-.-..__-___________.----.---._..__ I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County . ordinances, State laws and rules and regulations of the"oa ocal Health District. ($igned).------- - - -- --•-- --- 1 -- ------------------------- - -"--------------�•.-(O and or Contractor) � ---------- 6 --------------- -------------------------------- Y ------ ----------- = (Title)--------------- -- (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------- DATE- ' _ REVIEWED BY. - ----------- -- - ------------------------------------------------------------ DATE--------------- BUILDING PERMIT ISSUED --------------- - -------------- DATE--------------------- ---- ------------- _ Alterations and/or rgcommendations:_______ ��.~_.- -�t _, �r1-�• e�_ �-�c>> �2--__� r�x't --------------------------------------•-----------•--------------••-------•---------------------- ---------- ----- _ -------------•-- ---------- _ ------ ------------- •----------------------------------------------- FINAL INSPECTION BY:---- --= Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 31A 3-'63 F.P.CO, _