18998 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: I r q �7 -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No_ _ __ ____ ------------------ - (Complete in Duplicate) Date Issued - OSS 1Z -------------------------- - Issued This Permit Expires 1 Year From ate ed_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, This a plicatioo_is,made in compliance with County Ordinance No. 549. [ b .�LI j-r 4,14:;r�l`f �� A, J e JOB ADDRESS A CPFT10N.S-' _._Q-u''4-!►!w _ ... •-- --'�,A4,...a-'---- ----- Owner's Name ,` '��`--- -------------------------- ----- - Phone ••---- Address--------- `�'" �-� c ------- ---- --- --- --- ----- ........------------------••----.._.._------------ Contractor's Name �e�r / ----------- Phone----••-•-•----------••-----------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . r Number of living units: ---/__ Number of bedrooms __ Number baths f____ Lot size ___________ ____________ ____. --------------- Water Supply: Public system ElCommunity system El Private epth to Water Table Character of soil to a depth of 3 feet: Sand I—] Gravel E] Sandy Loam ElClay Loam [rClay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------,........) No ❑ New Construction: Yes ❑ No ❑ 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-------------------Material__'_.______________...______.__ _.. y:`-'__. ❑ No. of compartments--------------------------Size---------- ------Liquid dep.h------------------ ------Capacity--------------- ----- Dispos field: Distance from nearest well---T4V__.._.Distance from foundation----j4!---------Distance to nearest lot ine__;s.......... Number of lines-----------/__._..___---_j__ Length of each line____j__0_d_._..,___-.-_.Width of trench-_._142__ _____________________ Type of filter mate rial_ ______Depth of filter material------/_f__r..____Total length__________/_42_0.__I!____.___....... Seepage Pit: Distance to nearest welL___________________Distance from foundation--------------------Distance to nearest lot line__{_.._--------------- C El Number of pits--- ------------------Lining material-----------------------Size: Diameter------------------------Depth------------------------------- Cesspool: --'Cesspool: Distance from nearest well_______ _______Distance from foundation-------------------.Lining material----------------------r-..... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity- ---------------------------gals. � Privy: Distance from nearest well---_--------- ____------------------------------Distance from nearest building--------------------------___________.._. �•/ ❑ Distance to nearest lot line------- ----------------- -- ----------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- i ' � . --------------•--------------------------------------------------•-----.----------------------------------•----•-------------•---------------------------------------------------------------•------------------------------- N ------------------------=-------------- 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 rules and regulations of the San Joaquin Local Health District. Si ned f -- - /or Contractor { 9 }-- = - B ----------------------------- ---- ------------ (Ti#le�_ (Plot plan, showing size of lot, location of system in relation to wells, bur ngs, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ t `r'!___. • DATE__ REVIEWEDBY------i------------------ - ---------- ---- ---------------------------------------------------------- DATE-------------------•-------- BUILDING PERMIT ISSUED ----r----= - "-t ------ DATE---- ---- __________________________________________.-._____________._._ .----------------------------- Alterations ._____.-____.___________.._.Alterations and/or recortimendations:- ------------------------------ ------------R-•--------------------------------------------•-••----------••-----------------•------------------------------ I -------------------------------------------------••-----------,--------------- ------- '----- _________________________ ______________-----------------------------------k ------------_-----------------_----------------------------___'..._-°..-__.-_---_-.-_...___.__________.____._________________.__....._-.._--.....-_--__.____._______.___._-____-_.___._..._____._._ _ .--- FINAL INSPECTION BY:. ---tea -------- -------- Date--- '"-�� .'� Imo" - --� - - -- --- --- -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th street Stockton,California Lodi,California ManteWr California Tracy,California ES 9 REVISIZO 8-S9 3M 3-'63 F.P.CC.