16737 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATIaN-FOIR SANITATION PERMITPermit No. ___,1.�. .-J�_..7 f d: ------- [Complete in Duplicate) _ /;L / o ' This Permit Expires 1 Year From Date Issued 1 Date issued _________ ___� Application is hereby madWto the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with Count .Ordinan No. 549. 1 JOB ADDRESS D LOCATION ----• -- ------ ----- ------------ Owner's Name- 114Zi_,/4- -----"-- - ------ . Phone-------------------•--- Address-------•---- _ _... -€-------•- ----- -- ---- -------------------------- ----------------------- -- -- Contractor's Nam e_- -_ -.. _- -__-- -- _ �S.�C�I�� i------•--- EE Installation will-serve: Residence ❑ Apartment i'9ouse ❑ Co mercial ❑ Tra' r Court ❑ Motel ❑ Other Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size __._--- �� --_ Water Supply: Public system 2--`Eommunity system ❑ Private ❑ Depth to Water Table _rft. Gr Character of soil to a depth of 3 feet: Sand ❑/ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe ®Hardpan F1Previous Application Made: (if yes,jdat4/30/-`r el, No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYP OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] S tic Tarp: Distance from nearest well-----------------Distance from foundation____._.___________.Material-___.____._.___.__._______________._a r ,1 No. of compartments-------------------------Size------------------- ---------Liqui�epth------- ------Capacity...... --- ---------"/ o Distance from nearest well�-t-a- ___Distance from foundation-__`_______.___Distance to nearest lot line:___.._ Number of lines------�______ __.__ .�___ _ ._Length of each line_______s �-- ------.Width of french-__._- dType of filter material 4..__- -__Depth of filter material----/: 7--`-/----Tota! length________cz;2_=L9__r______________ e Distance to nearest well�-�-.-______.-- _DisTanc, rom foundation____. ___. i adcfe to nearest lot line__.__If�____ } E Number of pits---- Lining rnaterial_ �' -Size: Diameter. ..___...___Depth__��.`__ ___2 ` Cesspool: Distance from nearest well_____ _________Distance from oundation-----------------_..Lining material-------------------------------------- Size: Diameter ----De Depth ------------------------------- -- - ❑ l ,� Liquid Capacity = gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------- ----------- ---------------------- ---------------------------------------------------------------------------------------------- Re o Jing and/or repairing (describe):----- ...... ---- -------- __ -- - '------------------------------------ T ---- ------------------------------------- -------- -------- ------------- ------•-----------•------.------. ------------•--------1 -------- � ------------------------------ I hereby cern y that I have prepared this application d that the work will be done in accordance with San Joaquin County ordinances, St a 'r�s, rules and 1, ulations of the S Joa uin ca a istric (Signed)---- ---- ------:----- '�' -- ------- -- - A----`----------( _ r Contractor) By:---------------------_----.. ---�---•---------------------- ------=--------- --- --------- - -------- -----------(Title)---------------------------- -------- ........... --- --------- (Plot plan, showing size of lot, location of system in relation wells, buildings, tc., can be placed on reverse side). ,,, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ' - d�1---- a-- ---------------- ---------------------------------- DATE 'i '� `' REVIEWEDBY--------------------------------------------------- --- -------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED. — ----------------------- DATEAlterations and/or recommendations �r _____ ._ ___------� _ ____-_. ^^0 --- -- - ---- - - ------- � ---- --------- ____.__ __ _ __ .___ " . _ - _ _ _ ._._ __ . _ -. ------------------------------------------------------------- ---- ----- -- ., � .� 7 FINALINSPECTION BY: -----•-------------------- ---------- - -------- Date--------------------------------- ------------------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Norelton Ave. 300 West Oak Street 124 Sycamore Sheet 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 f.A.Rq.