17008 - Laserfiche WebLink

Home Browse Search

FO OFFICE USE: ------- - ------ --- ------ .. l APPLICATION FOR -SANITATION PERMIT Permit No. ..f!_- �-_ - - ""`- (Complete.in Duplicate) Date issued This Permit Expires 1 Year From 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 ---------------------------------------•-•----- Owner's Name h(,� Q --------------------------------------------------------------- -------- Phone--------------------------•---•---- Address ........ � f.�. - Contractor's Name--- ----~ -/ -�f/3f Phone Installation will serve: Residence [�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms -_/__ Number of baths _.f__ Lot size -------------- ' Wafer Supply: Public-system UK-c—ommunity system ❑ `Private ❑ Depth to Water Table !�'ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑. Clay Loam [] Clay ❑ Adobe g?'dardpan ❑ Previous Application Made: (If yes,date....................) No �New Construction: Yes ❑ No FHA/VA: Yes ❑ No R;, -- 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____--�____Dis#ante from foundation----fe-_r____'Mate ial__�_��f'� ------------ Isla- -..__..-_. [L� No. of compartments______ ,t � '__Liquid depth._. �_ --------Capacity-__� _0-____- -------------Size ---- Disposal Field: Distance from nearest well._.____ Distance from foundation-_-AA_.r 4� - ________Distanca to nearest lot line_a�__._-_____. Len th of each line__.. 20-------�____.Width of trench___2.",----------------------- ®/1�dk�� Number of lines-------- _ g Type of filter materialDepth of filter material____ _______.Total length______�. __:__.__.______:________ St, page Pit: Distance to nearest fwell----------------------Distance from foundation---------------.___.Distance to nearest lot line____________._. Number of pits----------------------Lining material-------------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: / Distance from nearest well-----------------Distance from foundation---.---------T-----Lining material-------------------- ..--_---.--.-.-. N ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---_-----------------------------------------------Distance.from nearest building------------------------------._________- ❑ Distance to nearest lot line-------------------------------- - ---------------------------------- ------ � y Remodeling and/or repairing {describe)------------- L� G��I�3x - /�-- - -------- ----------------------•--------------=------------------------------------------------------------------------•-----------------------------•----•-------------------------=---------------•-------------------------I------ S I ------l ----------------------------- ------------------- -----------•---- ------------------------------------------------------- ------------------------------------------------------------- I hereby certify that I have prepared this application and that the-work will be done in accordance with San Joaquin County 1r ordinances, State laws, and rujqs and regulations of the San Joaquin local Health District. (Signed) = Contractor) By--------------------------------------------------------------•------ = Title) /s' (Plot plan, showing size of lot, location of system in relati wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ` 4f- ---------------------------------------------------------- DATE----- �------------ REVIEWEDBY------------------------------------------------------------ --------------------------------------------------------=----.,DATE--------------------------------------- BUILDINGPERMIT ISSUED----------------•---`--------------------------------------------------------------------------------- DATE----------------------------- Alterations and/or recornmen ations_______ ___---------------- --------- ---------------------------------------------------------------------- ---------------------------------------------------------------- --------------------------------------------------------------=------------ --------- --------------------------------------------------------------------------- ----------- ------------------------------------------------ --------- ------------------------------------------------------------------------- ----------------------------------------- - ---------------------- ------ .,J- FINAL INSPECTION BY: ,---- - --------------------------------------- Date ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. s 300 West Oak Street 124 Sycarnore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3•'63 F.RCD. '