16366 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. __. (p��P,� •� --------------------------------------------------------- - (Complete in Duplicate) - I v 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 applicationerii�3n Co�ian it County Ordinance No. 549. 1, ---- ------------------- Address 4 dDDRESAALO�C, ON-� - . ---- --JOB A - • E ----------------------------- - PhoneOwner's Name � /Z - Address-------------- - S Contractor's Name-----_-__ p Phone.._.......`.............. Installation will serve: Residence [Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../_-- "Number of bedrooms _4-. Number of baths -;..- Lot size __./�._ --------------------------------------- ' Wafer Supply: Public system .❑ Community system ❑ Private fft'TDepth to Water Table . .d ft. l Character of soil to a depth of 3 feet: c Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe['Vardpan ❑ Previous Application Made: (If yes,date-- ------------ -I No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No C� TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ �c Septic Tank: Distance from nearest well ---.-_Distance from foundation-14t---.__.--__.Maferial_4-�r:Cr�.�4.--.��1�°d,.�- [� No. of compartments---__-�---------------Size_ .9'S. X_---------Liquid depth---I!---------:------Capacity.__ "' r f &_;Kl Disposal Field: Distance from nearest well._--------Distance from,foundatlon.4--_.-------.Distance to nearest lot line_--------- W Number of lines...__._ ___ ----------------- of each line-__�S1----_-----------_Width of trench__9..f.__".___.._..-____ __-- Type of filter materia.: .�C�C_________Depth of filter material �_y_---__-_____Total length-:1-�A.----------------j-___------_ vi Seepage Pit: Distance to neare12 st'welL_dDd_____.___.__Distance from. foundatio ---------------Drstance to nearest lot line................_ , r [ � Number of pits-.}. ............ Llning materiaf__11S?.0 A-_---.Size: Diameter-__33__9-..---_Depth___a5____------_-_.--- Cesspool: Distance from nearest well_-_-------------Distance from #oundation __.._.Lining material-------------------------------------- El ...----___.----- .____._____---.--.❑ ------------------------------Size: Diameter---- De th------------------------------------------------------Liqud Capacity--�------------------•--:---gats. iv� J � Priv Distance from nearest well---- ---------- --------Distance from nearest building - "� { Y g-------------------------------- ----------- Distance ----------- A ❑ Distance to nearest lot line----------------------------------------------- ' rV Remodeling and/or repairing describe) ---------------------------------------------•-•------------------------------•---------•-----------------+--•------••------------•-•----- --. -------------------------------------•-----•-------•--------------•--------=-------------------------•-------------- ----------------------------------------------------------=---------------------------------------- ----------------------------------------------------------------I-----------------------•- ------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that i have prepared this applicatio and hat th work will be done in accordance with San Joaquin County A ordinances, State laws, and rules and regulations of San oaquin ocal Health District. Owner and/or Contractor (Signed)----------------------- -- . . . . •---- ( ) (Plot plan, showing size of lot, location of system in re ation to w IIs, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ..-- *- , �`~� ------------------------------- DATE......./ -` -2 -- -- -- ---------=-------------------------- ---------------------. REVIEWEDBY------------------------------------ -- - -- ---------------------------------------- DATE------------------- BUILDING PERMIT ISSUED---------------- ------ DATE -- --------------------- -- ---------- Alterations and/or recommendations--------- -. mac-z� ._ ""a f).lv— ----e�L _-__--_-._ ` -'• 1_'r`1_� q--------------------------------------------------------------=-------•- --•--------------------------- -------------------------------------------------------------- •--------- -------------------- --------------------------------------=-------------------------------------------------- ------- -----------------------f -----•---------- ------------ [--- --- i: t / - C' FINAL INSPECTION BY:. - ------ Date -------------------------- --------------------- jrS) NN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.p.L*O. f�