17706 - Laserfiche WebLink

Home Browse Search

-- FQR OFFICE USE: 1 �. ,_y-___-------_�-----. APPLICATION FOR SANITATION PERMIT Permit No. ._,1.- _ p_ ------- --�---------=------------------------- (Complete in Duplicate) ----------------------------------------------------- a This Permit Expires 1 Year From Date Issued Date Issued --- -�----------� Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION__ . ---------------------------------------------------------------------- ------- . � Phone------------------------------------ Owner's Name------- � _ y� Address-------- 1---------- -- ----------- -------------------------------•----------------•---------------------------------------------------------------------------------------------- Contractor's Name-----• - ��y� - ----------------------------------- -----'-------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Number of living units: _--`- Number of,bedrooms ,_-_.,Number, of-baths - ------•Lot.size Q�___ .- -J� ------------ WaterWater Supply: Public system ❑ Community system ❑ Private'[�Depth to Water Table ft Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe 0--lHardpan ❑ Previous Application Made: (if yes,date--- -------------I .No New Construction: Yes ©--I�o ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: • I - . (No septic tank or cesspool permitted�if public sewer is available within 200 feet.)- .. Septic Tank: Distance f om nearest well_-,��__.__Disfance fom foundation---f ________.Mat�ri fL__�r- ----------------- �� _.___Liq, de th._._ Ca acit >_�e--.--. ❑/' No. of compartments---_g�-----------------Size_ --- ---- --- - - q P. P Y Disposal,Field: Distance from nearest -----Distance from foundation--- -----Distance to nearest lot line___,?_.__.__.__. Number of lines--.__°___ Len th of each line-- /10---_._022 Width of french.-,'Z-/------------------------- Type of filter material- Depth;of filter material___ �-_-____-Total length---,la _ ________________________ Seepage it: Distance to nearest%well..../1_�, ___Distance fr9m foundation----ZZ9.._ to nearest lot lin-j--_-.----.-f 06 Number of pits-----rrZN---------------Lining material_._ _. _ Size: Diameter__.� _ .._...__.Depth ~_____________________ Cesspool: Distance from nearest well.-------------- Distance from foundation-- _---_---..Lining material--------_----___-_-----------.--._. tfi ❑ Size: Diameter---- -----------------\'- ----------Depth_---------------- t----------------------------------Liquid Capacity------- -------gals. Privy: Distance from nearest-well------ -------------------------------------Distance.from nearest building-------------------------..--._--.---_--- Distanceto nearest lot line---------- �s----------------------------- ----------------•------ ------------------------------------------------- ----------- Remodeling and/or repairing (describe):`'-- -=:,2z ------------------------------------------------------ --------------------------------------------------------------------------------------------- -------- - i ---------------------------------- ---------------------------------•-------....-------------•------------------------ f 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. I •� t � _ jGw /or Contractor] r (Signed) Y' ------------ ---------- -------- , - B --- � ------ C,r e] r�' (Plot plan, showing size of lot, location of stem in relation.to Wells, build ings,..etc.,ean..be_placed on reverse side). I. .177_---FOR`UEWTMENTYUSE ONLY—,�-; I ��—L APPLICATION ACCEPTED BY---- - -tet e DATE ��- REVIEWEDBY----------------------------------------- -------------------- --------------------------------------------- T -------------•-------- DATE BUILDINGPERMIT ISSUED---------------- ----------------------------- -----------------------•--------------------------- DA ----------------------------------------------------- ----- Alterations Alterations and/or recommendations: -------- ------------------ = - ' `I-Z' 17 - X - --r�---- S --------------- -------------------------------------------------- - ------------------------------------------------------------------------- -----•--- ---------------------- ---------------------------------------------------------------------- ----------- FINAL INSPECTION BY:. ------------------ --------------- Date-------------- a3 bra SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton-Aver -300 West Oak Street y 124•SycaioCre Street 205 West 9th Street Rte. Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3^'63 r-P.CO.