17227 - Laserfiche WebLink

Home Browse Search

1-UK IIJI•H' E USE. ------------------------ - - -- ----- ---� _ -_ APPLICATION FOR SANITATION PER -_-- T�- - ,��,,p MIT Permit No. _ ;7 ------ f.7fi ."----7;"15 (Complete in Duplicate) / This Permit Ex i 1 YJ ------ ---- --- --- res Year From—Elate ate Issued bate Issued -i------�/�- 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 wi#h County Ordinance No. 549. JOB ADDRESS AND LOCATI Owner's Name----------_. - Phone.__...----•------•--.----- Address---------- - --- _"'i---------- Contractor's Name_..___.__" 4 ----------------1-••---_------ •-- ---------------•--- - Phone------- Installation will serve: Residence �t y ❑ Ap artment House ❑ Commercial �] Trailer Court �" Motel }}�� ❑ Number of living units: --/.- Number of bedrooms ./ _-_ Number of baths _f.-_ Lot size Water Supply: Public system Communit system ❑ p t Y Y ❑ Private Depth to Water Table _--_,,/'Character of soil to a depth of) feet: Sand El Gravel ❑Gravel ❑ Sandy Loam Clay LCl ' �, [�ardpan E]Previous Application Made: (If yes,date_--__._-----_----:_1 No R`—New Construction: Yes E/ ay ❑ Adobe No ❑ FHA/VA: Yes ❑ No Z�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)"0" _d Septic Tank: Distance from nearest.-well --._-Distance r2m foundation__ - _ t ---------.Mat i I___ sr No. of compartments"___ „-- �'' --------- y... Size •-Liquid depth ------Ca acit __ --- Disposal Field: Distance from nearest well----_"-��"-_-- p y --""" Distance from foundation__'e------Distance to nearest lot line.-1_"-"" Number of fines___.__-/ __,-,..__ ___-____ "Len fh of each line--- � � -----Width of trent Type of filter material .4 of filter material--- - f -- t _-____.Total length___ Seepage Pit: Distance to nearest well_--_. .�------ "-' Distance:fr-m foun tion _ Distance to nearest lot line_S- Number of its--_-- !� 1 Lining material' - ize: Diamete r��"'e p Cesspool: Distance from nearest well-___-____-__ -Dist ce f oundation--------------------Lining material______________ ❑ Size: Diameter--'----------------------------------Dep#h---------------------------------------------------- .---------- Liquid Capacity ---------------- --- gals. 0 a Privy: Distance from nearest well-------------------------- - --- Distance from nearest building ❑ Distance to nearest lot line---__---- g - ---------- Remodeling and/or repairing"(describe):,.._____--- �' : --- -------- ---- - ,-- J--1---- -- -- - -- ---------------------- -- •-- .----- of-7�------ Z-1 - - ----•- ------ ----- ----- - ---- - - -- - --- -- ----------- - ----- ---• - -------- - 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 !es and regulations of fife San Joaquin Local Health District. �+ (Signed)-----------------#040 - --- ---------- - ----- ------- ---- --------- (OOw"er-.aod/or Contractor) BY-------------------- ----- (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------ -. '--- c�, ----------- ----------- DATE _`"7- REVIEWED BY --------- ------------ ------------------------ ------ DATE BUILDING PERMIT ISSUED____ -----------------------------------------------=-------------------------- -------- Altera ons and/or eco n fto �` - ---------------------- __�7 - -� ---- - -- ----- ---------� ----------- - ----- ------------------ -! � -" --------------------- _�-.__n��-----f------ - .-- -------" ----------------------------- -------------------------------- --------- ---------- -- ------------ FINAL INSPECTION BY:------------------------- Date. --` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Howellon Ave. 300 West Oak Street T24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CO.