17123 - Laserfiche WebLink

Home Browse Search

1-UKUtflU U61z: --------------- ----------------------------------------- ------------------ -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------- --- d. (Complete in Duplicate) Date Issued --- ----------------------------:--------------------------- P This Permit ExfresI Year Froin Date iSZe,d_'1_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a pplication is made in compliance with County 2 rdinance No. 549. JOB ADDRESS AND�CATION_' -- ---- -------------I - ----- -------_---------- Owner's Na ---------- ---------- ------ ----- ---- ---- Ox� Address ------------------------------------------------------------------------------------------ Contractor's Name---- --------- ---- -------- - - --------V-------- -----------------------------------------I--------------------- Phone-------------------- - Installation hone---------------------------Installation will serve.- i Residence �Aparfmenf House ❑ Commercial E] Trailer Court E] Motel 0 Other Ej Number of living units: V--- °N,rber of bedrooms _3_ Number of baths cz2---- Lot size ! % ------I------------ Water Supply: Public.system E3 Community system*El Private "' Depth to Water Table XP_ ff. Character of soil to a depth of 3 feet:- Sand E] Gravel Ej Sandy Loam L] Clay Loam [-] Clay E] Adobe E] HardpanX Previous Application Made: (if yes,date.._._.t_�_v 1� - -----)� No El New Construction: Yes E] No V FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Distance from nearest well-----------------Distance from foundation__.----_--_----_-__Material-_--____- --------- No'! of compartments---------------:--------- ----------------------------- i --Size--------------------------------Liquid depth---------------- ---------Capacity-------------`--------- i p -Field: Distance from nearest well-----------------I '—'------------------Distance from f6undation-------------------Distance to nearest lot line---.-_--.---_--. Number ine----------------- Number of lines___.,_i_t------------------- --------Length of each line------------------------------Width of trench Type of filter material]---------------- --------Depth of filter 11 material-----------_.-----------Total length----------- -------------------------- --- SeV Pit: Distance to nearest weIIAQ4_J._.;0L---Distanceorn foundafion-,-/&-)-4>-.'-..Disfance to nearest lot linq_47�04_ Number of pits_.__.______________Lining maternal_ E��----Size: Diameter________ __.___ _ _ De th-_A�._47----------- ------- cess000l: Distance from nearest well________ --______Distance from founclation... ----------------Lining material--_- ---------- ------------------------0� ❑ Size: Diameter--- d ----------------1._------Depth----------------------------------------------------Uquid Capacity----------------------------gals. Privy: Distance from.nearest well__..___________________JA---"_!------ ------Distance.from nearest building-------------------------- n, Dista'nce to nearest lot line- -- --------------------- --- - '-t ---------------- low - -------------------------------------I-------------------------------------------------------------------- A I Rnqcleling and/or repairing (describe]:----__ __._._ --------------------- • - ---------------------------------------------- ------------------------------------_------------------ I-In ......... ------------------- --------- ------------- ---------------------------------------------- - ---- -- ------ - ------- ----------------------------•----------------------------- -- -------------------------- - -------------------- - ------------------------------------ ----------------------------------------------------------------------------------------------- - ------ ----- here!y certifythat I have prepaA this application and that the work will be!done accordance with San Joaquin County ordina'nc_1,f,fe laws, and rules and regulations of +he San Joaquin Local Health District. r (Signed)- . . . Owner and/or Contractor) _k ---------------- -------- - ----- ------------------------------- - .... ---------- --------------------- <w, r By:------------------ ------ - ------ ------------- ---------- ---- ------------------------ fie —- ----- (Plot plan, showing size of lot, location of system in relation foAells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ J BY-- DATE-_ ------------------ REVIEWED BY------------ ---------------------------- --- - ------------------------------------------------------------ ------------------------------------ ---------- DATE----------------- --------------- ----------------------- BUILDING PERMIT ISSUED---------------------------------------- ----- ------------ ... DATE---------------------------------- -------------------------- Alterations and/or recommendations:___.-_---___.-_----------- -----------------------------------------------------------------------------------------------------------------------------•------- ---------------------------------- , lr # , f I ------------ -------------- ------------------------------------ ---------- -------- ---------------------- I, ------------- ----- ` ------------------------------- ----------------- - ---------------------------7----------------------------------------------------------------------- --------- .......I....... 7------------ ------------------ --------------------------------------------- -- ------- ---------- ----------------7-------------------------------------------------------- -------------------------------- FINAL INSPECTION BY:-.--------- ------------------------ --------------------- Date------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Streets7. X124 Sycamore Street 205 West 9th street Stockton,CairFornia Lodi,California MantecV a,California Tracy, California ES 9 REVISED B-59 3M 3`63 F.P.M.