16586 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 0;—�>/—Cie/ 7--oz-- APPLICATION FOR SANITATION PERMIT Permit No. •_ -------------------------------------------------------- (Complete in Duplicate) / ----__ This Permit Ex ires 1 Year From Date Issued YWV 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. cr;- - JOB ADDRESS AND LOCATION.. .�c -..---- "', ''--------------x '1/1 ' Owner's Name--------. ----.... y ---- Phone------------------------------------ Address O --------------------- ---'" ----- Contractor's Name-------------0^4-----•- •------- 0114,-1-- ---------------------------------------------------------------------------- Phone....------------------------------ Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A----- Number of bedrooms _--f--_ Number of baths ---1- Lot size ----_� --------(/tr)----__-----_--_ Water Supply: Public system ❑ Community system ❑ Private [� Depth to Water Table _' � ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ❑ Adobe ❑ Hardpan Z Previous Application Made: (If yes,date-------------- No [2 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-_tF ---_Disfancee from foundation----/-0_..... ..Material_ ____________ __________ No. of compartments------r ----------------Size_Y_�-7'---1 --r------Liquid depth------5---------------Capacity---/-2'070----- Disposal Field: Distance from nearest well---d- -------Distance+om foundation--1 q----------.Distance to nearest lot line---S -_---__--- [ Number of lines-------�`------------------ ---Length of each line----- -atm------------Width of trench.--"- --------------------- Type of filter material _ d _Depth of filter material__-_l ``__._.._..Total length_. �� '_________________________ , Seepage Pit: Distance to nearest well----1---G--------Distance from oundation--_l0-___----.Distance to nearest lot line_--,5'---.-_--- 5� Number of pits..,-----------------Lining material_/Z-4/4 -------Size: Diameter-__/2r-".-----Dept h....�.L.�-'--------------- Cesspool: Distance from nearest well----------_---_Distance from foundation--------------------Lining material--.---_-------_-_-_.--_-_-__--._.---. ❑ 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)--------------------------------- ---------------------------------------------------•-------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- - ------------------------------------ ------------ ------------------------•------------------•------------------------------------------------------------------------------------------------------------------r------- 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 rubles and regulations of the San Joaquin Local Health District. (Signed).------e-� -f-�f ------------------------------- -------------- -------------[Owner and/or Contractor ------------ --------------------------------------- By-----------------••-... ------- ------------------------------------------------------------------------------(Title)---------------------------------------- - - -- --- -- (Plot plan, showing size of lot, loc tion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --------------------------------------------------- DATE---A- - --------------------------- REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------.- DATE--E----- BUILDING PERMIT ISSUED DATE -- ----------•---------------------------------------d� Alterations and/or recommendations------------------------------------- -------------------------------------------------------------•------ -------------------------•----•-------------- ------------------------- ------ ----------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------- ---•---•-----------•---•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ----------------------—........ ---------------------------------------------------------- ---------- ---------------------------- ------- ------------------------------------------------------------•--•------------------------------------------------------------------- FINAL INSPECTION BY:. �--- 10-""`-------------------- Date..... J�------------------ ----------------------. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 6-59 3M 3-'63 F.P.CD.