18860 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----- -------- ----------------------------------------- f� -------------------------------____.._-._._____.______ APPLICATION FOR SANITATION PERMIT Permit No. ._1 __-� --------------------------- ------ --------------------- (Complete in Duplicate) i -.-_-_____-__.._._ This Permit Expires 1 Year From Date Issued Date Issued --- t �---�� i Application is hereby made to the San Joaquin Local Health District for a permit to constr ct and install the work herein described. This applicationis made 1 comp lanc with County Ordinance No. 549. O2.S—1610 — JUis ADDRESS AND LO A 1 JJ �-- -- -- --- : i Owner's Name-----.14444 - ---------- ------ ^fil.A•-------------- Phone------------------------------------ Address--- �Contractor's Name----- ---- � r------- ------ ---------------- ------ Phone------•-----•-•----.i.............. 9 3 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms -1- Number o baths ___%_ Lot size --- -------------------------- Water Supply: Public system F1Community system [I Pi Depth tp Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑'- I-lardgan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes E] No ❑ 5 TYPE OF INSTALLATION AND SPECIFICATIONS: ( a septic tank or cesspool permitted if public sewer is available within 200 feet.} r , Septi ank: Distance from nearest well ___ r pQ r�__.._._�_______-Mater' t ._ ____No. of com artments- DZea f rtioa P. p y- -- ---p LI uid de th..._____ pacify Dispo Field: Distance from nearest well._ .__-__Distance from foundation____ ---------Distance to nearest lot ne-_�_.______ t Number of lines-------6 --- ..__ _. _____Length of each line___/e ---------.Width of trench_ - T e of filter material___ �f J� r -------- Type -�- - f Depth of filter material______.��_____�_Total length_._.___ 4�_._�.lC�__________________ e t -- k eep Distance to neatest well____�d_-_.__-___Distance from foundation___________ _______D�tance to nearest lot line_____..______ ` Number of Its----- /r �_4.Depth .._______________ ❑ p' f -__ _-___Lining matenaL_____r�' _ _______.Size: Diameter. .___. p - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____._...._______.__.____________. ❑ Size: Diameter-------------------------------------Depth----1-10t= "--------------- --- ------------------Liquid Capacity-----------------------------gals. A Privy: Distance from nearest well__________________________ ---------------___Distance e from nearest building:__._...____c____-____-_-.._---.---_----� ❑ Distance to nearest lot line -------------------------------------------- ----------------------------------------_----------------------------�/lo Remodeling and/or repairing (describe):- -------------------------- -------------•-•-------------------------•-•--------------------------------------- i t i ..,,,,m. ,-- ------------------------------------------------------------------•-•----_.}-----------------------------=---------------------------------------------------------------•------------------•-------------------------------- -----------------------•-----i------•-•---------------------------•------------------------------------ IF ------------------------------------ ----------------•---------------- ------------------------------------:-------: _: _ -----------------------------•--------•------------------------------------- I hereby certify that I have prepared this application,and that the work.will be"-done in accordance with San Joaquin County ordinances, Stateal , and rules and.regulations of the San Joaquin Local Health District. (Signed)--------------- --------------- ----••- -- ------- ---- - -- - --------�--�------- ----------------------------------------.` and/or Contractor] '��11 jBY:----------- ----- - -------- ------------ -- -- - -- -------------- -----------------------(Title)----------------- ------------ ---- ---- (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- ----------------------------------------------------- DATE__ _-3-C' ----- REVIEWEDBY------------------ --------------------------------------------- ------ DATE------------------------------------------------------------ BUILDING PERMIT°ISSUED--"--=- --:n=7=___ —.__---�'-=------ - �....4.=� _. _ DATE= ---------_""= - _ ---------- ---------------------------------- Alterations and/or recommendations---------- ----------=- -= ----'--------------.__._-----•---•--------...-------------------------------•------------------------------ ----•--------------------------------------------------------------------------------------------------------•---- -----------------------------------------------..... ----•-----•-•-------------------------------- -- - f ________________________________________________________________________________________________________________________________________________,___._.-________________..._________________-.-._._____._.______------ __• -----------------------------------------------------------•-------------_--.------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:. ; x----------------- Date =` .- .✓' -------- --------------------------- SAN JOAQUIN LOCAL,HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California JS{ ES 9 REVISED 8-59 3M 3-'63 F.P.DD.