20537 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ------------------------------------------------- -- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .,2z/- ------------ (Complete in Duplicate) arm --- -------------- This Permit Expires l Year From Date Issued Date Issued I----ji >f e... . 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. r ag3 � JOB ADDRESS AND LOCATI N--------fes�--^-L. G r ROS- ------------------� r► - -[l Owner's Name---------- 1`- - _i_i ----------------------------------- ------------------------------------------ Phone---. Address------.... ��5- �= --------- Q ------ - - ----------------------------------------------- Contractor's Name------ .. "� Phone.. Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -A---- Number of bedrooms Number of baths .2-- Lot size ----------- Z--------------------------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Uk Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Dr New Construction: Yes JR] No ❑ FHA/VA: Yes ❑ Nov TYPE OF INSTALLATION AND SPECIFICATIONS: �! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----dQ-----Distance from-foundation-_-._J.©.-.--.-.Maternal--- __....................................... No. of compartments---------- ---..-.-Size---- - ------ Liquid dep#h...... ---------------Capacity---l _Q_Cj-..-- r -r 4 / ../ Disposal Field: Distance from nearest well---/00-._7bI lstance from foundation.---2-----------Distance to nearest lot line----/-5.----- Number of lines--------- ........... ....._-.Length of each line -- An&-L . Width of trench........ .-._____-_-------. Type of filter materiallgrlrDepth of filter material-_--_- -----...Total length......._.. ----------- Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line..-----..---...._ ❑ Number of pits----------------------Lining material---------------.-------Size: Diameter-----------------------Depth-------------------------------. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter-------------------------- -----------Depth----------------------------- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___-_--- ----------------------------------------Distance from nearest builciin - r ❑ Distance to nearest lot line--------------------------------------------- -----------------...------------------------------------------------------- ------------------- Remodelingand/or repairing (describe):----------------------------------------------------•----------------------------------------- ----------------- -------------------------------------- --•----------------------•---------------------------------------------------------------------------------------------------...--------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- 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 San Joaquin Local Health District. (signed) - ----- ---- ----- (Owner and/or Contractor By:--------61 -� r----- --- -- A --- ------ ------------------------------------(Title)----------------- - -----�..r. �,c.E.ri ..------- (Plot plan, showing size of lot, location of syste to lafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ----------- ----------------------------------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY---------------------------------- -----------------------------------------------------------------•-------------------- DATE---------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:---------- ----------------------- --- -------------------------------------------------•------ ---------------•---•------------------------------------------- ---------------------•------------------------------------------------------------- ------------------------------------------------------ ---------------- FINAL INSPECTION BY-- ------ Date------ ------ � �(/. ------------------------- ---- ------kl--- ------------ •- -- ---- -------•- -- ---- - } f490 1 S SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Haxelj. 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 8-'63 F.P.CD.