17050 - Laserfiche WebLink

Home Browse Search

F R OFFICE USE: J ` APPLICATION FOR SANITATION PERMIT Permit No. _ ;_ ----------------------------------------------------------- ---------- - {Complete in Duplicate)------------------ ----------------- Date Issued .---------Y�l-�.. ___ --------------_------------------.---------.----- -- 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 LO ATiON_ .-- 1� �'.r -�'``' ' ------------------------------------------------------------------------ --- ----------- -- ----------------------- Owner's Name---_ `.4h ----- Phone------------------------------------ �/ Address------ /2. -o----- = �---•--- -----------------• ---•----------------------------------------------------------------------•------------------------ Contractor's Name------- -- ----------&------- ---------------------•--•---------------•------------- --------------- Phone----------------------..._ Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [IMotel E] Other E] Number of living units: __l____ Number of bedrooms X_ Number of baths __l..-. Lot size ._55.0 ,( 5_-a ____ --------------- Water Supply: Public system Pr—Community system ❑ Private ❑ Depth to Water Table A-4 it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe hardpan ❑ Previous Application Made: (If yes,date--- ----------------} No New Construction: Yes EA-1Go ❑ FHA/VA: Yes ❑ No (— 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-__---------Distance from foundation_ZP_�__.--____.Material_/CR_ __Vol �1, - 1 M� No. of compartments__—_________-___Size_____-_y _ _7X_-)r__.___Liquid depth___ _................Capacity..._- ___ Disposal Field: Distance from nearest well. ._____Distance from foundationJ-0___-----------Distance to nearest lot line__._______ Number of lines---- ________��_ ._______`_______Length of each line___�l1_'_______________ Width of trench-.?-9�___..____...________ A Type of filter material_'_4ip.G__-4 K-.____-Depth of filter material: __ Total length______ _ _�_______________________ IF Is/ Seepage Pit: Distance to nearest well____________________Distance m foundation___ a------------ to nearest I lid - r Number of its---- - rr p �y- - -- Lining material-----=r! B-G-'�-----Size: Diameter �i3 ....... Depth---------- -------/11--------------- J Cesspool: Distance from nearest well-----------------Distance from foundation.-..--------.-------Lining material-------------------------------------- El Size: Diameter-------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals, IE Privy: Distance from nearest well------_____--------------------------------------Distance from nearest building------------------------------------------ r ❑ Distance to nearest lot line-- --- --------------------•------------------------------------------------------------------------------------- -------------------------- V Remodelingand/or repairing (describe):---------------- ----------------------------- -----------•------------------------------------------------------------------------------------------ -----------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------•----------------------------------------------------------....---•---•---------------------------------------------------------------••------------------------------ �y -------------------------------------------------------------------- -------•--•---•------------•---•----------------------------------•------------------•----------------------•----------------------------------------- ---------------------------------------------••----------------------•-•---------------•----------------------------------------------------------------------•------•---------------------------------- I hereby certify that I have prepared this application and that the wor"ill be done in accordance with San Joaquin County ordinances, State laws, and rules and retions o the San Joaquin Local Health District. (Signed)----------- -------------------------------•------ ------ ---------------------------------- ---------------------------------------(Owner and/or Contractor) By_--_-------------------------- ----- ------- - =-- - -------------------=----`-----------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size o o . n of system to lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------- Gam- -----------------,---------------------- DATE------- ------------------ -- REVIEWED BY-----------------------•-------------------- ------ DATE---------- BUILDINGPERMIT ISSUED------------------------------------------------• --------------------------------------------------- DATE-------------------------------------- --------------------- Alterationsand/or recommendations:----------------- ---------- ----- ----------------------- -------------------•----••-•--------------------•---------------------------------- -------------------------------•---------------------------------------------------------------------------------••------------------------- ----•-------------------------------------------------•------------------------. -----•----------- ---------------------- -------- -----•--------------------------------------------------- --------------------------------------•------------------------------------------------------------------------- --------- --- -----------------------------------------••---------------------------------------------------------------------------------• -•---- ---•-------- ------------------------ ------------------------- FINAL INSPECTION BY---------------3 l _�--�-----------;-_---___--- Date_..__-- -- LI-11 JOAQUIN LOCAL HEALTH DISTRI 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED 6-59 3M 3-'83 F.p.CD.