16602 - Laserfiche WebLink

Home Browse Search

FO?OFFICE USE: : --------- ----- `30 / ------------------------------------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. ...,) 2 -------- ------------------------------------- ---------- (Complete in Duplicate) _ _ Date issued ----------------------- i ---------- From Date Issued ----'.-.---..-----..-- - This Permit Expires 1 Year Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application s made in compliance with County rdlnance No. 549. JOB ADDRESS ANP LOCATION 34,3---------- ------ - - -- -- - ------- - � - --- �- \ q - ----------------- � Owner's Name-- �- --- - --- Phone---.._.------------ -- :-.....-- Address------ Contractor's Name--- - ...........-- -------r •-----------------------------------------------------------------=------------------ Phone--------------------------------- Installation will serve: i Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ______ Number of bedrooms ._ Number of baths -1----- Lot size ,> X__rk�_________________________________ Water Supply: Public system El Community system ❑ Private Or"Depth to Water Table _14- ft. Character of soil-to a depth of 3 feet: Sand ❑ Gravel ❑ S y Loam ❑ Clay Loam E] Clay ❑ Adobe Hardpan E] l Previous Application Made: {lf yes,date__.._,_.___,_______.) No New Construction: Yes 5j<o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-4 __r___-Distance from foundation__�Q�________.M trial . ------------------ ` [ No. of com artments_--2---____ _-_Size__ V "Y�'__....Li uid depth �aG ry� �4 P r ----f- - -- � --- ) q t P. ------------- - -CapacitY-� ------- �Y � Des os geld: Distance from nea est well:.-____.__.Distance from foundati n_��_________-.__Distance to nearest lot line_` -___�______ r .. P j Number of lines_'l --------------------Length of each line_. ------------------- of trench_a��------------------------- Type of filter material-300K Depth of filter.material._Lr...............Total length----� -------------------------------- Seepage t: Distance to nearest well/ e_------------Distance from foundation__iC0------- ------Distance to nearest lot line_J Number of pits__111_________________Lin•rng ' matenal._ Q_C. __._-_Size: Diameter-- 47.------------Depth----�,�'----------- ---- a Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._.______.______-____-_____---____ ❑ Size: Diameter--=----------------------------------Depth---------------------------------------------_-----Liquid Capacity----------------------------gals. Privy: Distance from nearest well---_-----_---------------------------------------Distance from nearest buildingI Distance to nearest lot line-------------------------------------------- - --•-------------------------------------------- Remodelingand/or repairing (describe]=--------------------------------- ----------------•-------------------••-------------- ------•---------------------------------------------------•---- i ---------••--=--------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------•-------------------------------- - - -•--------- ------ ---------------------------- --------------------------- -- --- - --- -----•--------------------•--- ------- - ---- ------- ------------ ----------------------------- ----- ------- - ------ -------- I hereby certify that I have pre"ared this application and that the work will be done in accordance with San Joaquin County " ordinances, State laws, and rules egulafia of the San Joaquin Local Health District. (Signed) ------------------------------------------ -•-;------ --------_- ---------------------------------•--- -----------------------•-----------------(Owner and/or Contractor) BY: -- ----- --- ------------- ----- --------------------------------------------------- ---(Title)--------------------------.------------ (Plot plan, showing size of lot, loc ion of system ' relafion to wells, buildings, etc., can be placed on reverse side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---------------------------------------------------------------------------------- ----------- DATE-----I-,--=----1_-�>- 4?--�--------------- ---- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------- = - -------- DATE-- ii Alterations and/or recommendations:___ ` — �----- 1 1- - .+7 ------_--� --�- 3 ---------------------------- -----------------------------------------------__--------------------------------------------------_---------_______-------------- _______________l___.-.___.--_-._-___________________-___.___________________-_._ .... ......... ---- -.-.-__.--------------------------------------------------------------------------------------------------.---___.__._.___________.__._ 7 s a FINAL INSPECTION BY: `' -- �--- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r' 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stocklon;California Lodi, California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3•'63 F.P.Ca.