16288 - Laserfiche WebLink

Home Browse Search

:FCO) :FFE USE:--------------------- APPLICATION FOR SANITATION PERMIT Permit No. 1--•- --------- ----- ----- -----= ----------------- _ (Complete in quphcate� - Qate Issued ---- ---This Permit Ex ires 1 Year From Date Issued---- Application is hereby made to the San Joaquin Local Health District for o a permit to construct and install the work herein described. This application is-made in compliance with County �C'r fCoO�� Zt ! ,:_,.. �`/ ------ ----•-----------------------•----------- -.rte !-•---- --------• ----------- -- JOB ADDRESS AN♦ 'LOCATION_ e - --- ►- ------ Phone--------------------•------•----•--- --------- Owner s Name----"---- --�� -+--' - •----•--------•-- --" Address --------------------------------------------------- Phone..-------------------------•------- - -------------------------------- �� i Other Contractor`s Name____ ._. Motel ❑ ❑ Installation.will serve: Residence [�t Apartment House ❑ Commercial ❑ Trader Court ❑ Number of living units: -1----- Number of bedrooms _J7_ Number of baths -`---- Lot size '--- Water Supply: Public system ❑ Community system ElPrivate J� Depth to Water Table;! �-' ft. � Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 fee+: Sand E] Gravel [I Sandy Loam 4} Clay Loam ❑ Clay ❑ VA: Yes ❑ No ❑ Previous Application Made: (if yes,date............--------) No ElNew Construction: Yes E] 'No E] FHA/ TYPE OF INSTALLATION AND SPECIFICATIONS: OD feet.)"' - (No septic._tank.or:cesspool permitted-if-public-sewer is available within Z - .. G' t?" � ,.- - `'Size-n -- fr m foundation---1a-------- .Materia-- - - - - ------------- --- Septic Tank: Distance compar#me }s}well r _Dist Distance �� ± _Liquid depth------�----------------Capacity----• :'�---l----------- ��..-_.....Distance to nearest lot line_.-_----•--- Kri Disposal Field: Distance from nearest well, 0_.'_._Distance from foundation._-...... .-Length of each line_-.� ------------------Width of trench....--------- 1 Number of lines..-.-�---•... ... ........ g Total len th --.9 i Type of filter materia '.fl --_Depth of filter,material------�_r�_--- 9 i t Seepage Pit: I Distance to. nearest wel_------ ---- ---,Dis Distance a from founds ZE nDiameter Distance tonearestlot Lina------------------ Seepage --__--__----•- ! Number of pits------ --- ----- -L g ❑ ' g ------------------------------- Cesspool' --- -------- ------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Liquid Capacity----------------------------gals. Depth-,-------------------=------ ❑ Size: Diameter--- -------- ------ ------- -=---- - --------- ---------------Distance from nearest building._..,------------------------------------ Privy: -------,----------------------- y. i . Distance from nearest well-_--------_- ..-----. _------_---- Priv ----- ❑ Distance to nearest lot line----------------------- Remodeling and/or repairing {describe: ------------------- - ------------------------- ------------ I ---------- --------------------------- -------------------- --- --------- -------------------•--------------------------------------------- wil l I hereby certify that I have prepared this application ati San Joaquin i the L cal Health heDistrl�}n accordance with San Joaquin County i ordinances, State I s, and rules • .. -------_--._- (Owner and/or Contractor) .------ - ' -r -------- (Signed)--------` Aa- (Title) .U [e� y --= ------ _._.._ . : . By.:-------- -- - s: (Plot plan, sh Ing size of to+, location of em in relation to wells, buildings, a#c., can be placed on reverse side). , t FOR DEPARTMENT USE ONLY A= DATE.-f'__,,P--------00 APPLICATION ACCEPTED BY-- .. . - - - - ---------------- DATE-----------------------• --------------------------------------------- - ------------------------------------ REVIEWEQ BY-------------- ---------------- -------- ----- - .- ------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------- --------------------------------------- ---------------------------------------- -------------------- ---------------------- Alterations and/or recommendations:---------------------- ---_..__.-..--..- •--------•------ -----•........ - ------------------- _. d a ------------------- ;f/ . .. Date--- - - --- --------- -- --- --- FINAL INSPECTION BY:.--- - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, � 300 West Oak Street 124 sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stacklon,California ES 9 REVISED 83 59 3M 3-'63 r.R.CC-