16361 - Laserfiche WebLink

Home Browse Search

FO OF PI US 0 U , ---"- �" �r 6 � APPLICATION FOR SANITATION PERMIT Permit No. �. - - ------------------------------------------------------ (Complete in Duplicate) Date Issued _.. -__ This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54 . JOB ADDRESS AND LOC VO -----------------------------• ----------------------- Phone----------------- ------------------ Owner's Name---- Address :l / W =------------------ ---- Contractor's Name----------- -- --------•--------------------------•----- Phone----•---•----------- ---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "_I-- Number of bedrooms%?-___ Number of baths l>4_ Lot size 1 lKfJrZ------------------- ----- Water Supply: Public system ❑ Community system 98"T"rivate ❑ Depth to Water Table A;p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe & Vardpan ❑ Previous Application Made: (If yes,date-----------,_.._----I No jel New Construction: Yes �lo ❑ FHA/VA: Yes R' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0. Septic Tank: k: Distance from nearest welL__��-----Distan�a!from foundation__- -- Mate � �� . -•--- �,/j�iK �' ��jj -Capacity- a acct pp��--- No. of compartments---A-----------------Size_Tl�--r�� '---Liquid dep h_f � P Y 4 , �► Disposal ield: Distance from nearest well___"~'"._.__-Dist ance from foundat1 n__f _______Disfiance to nearest lot line_ ---___. e ! �• Number of lines___---ce+__ _______ _Length of each line-_A0 ---- -- Width of trench-- --�---------------------- ------------------------ ------------ ----------------- 0 Type of filter material �Depth of filter material Total length_ - 6 f�--4_.. Is a�e to nearest lot line__ ___-_ 5eep�aci�it: Distance to nearest well.____---------Distance fr m fou dation___ ti____. -_-- Lining material .Size: Diameter- _----------Depth. ' ------=------------- Number of pits--_ t t Cesspool: Distance from nearest weil_�_.__.__--.-Distance from foundation_____\ -_-___,.Lining material__________________ gals ❑ Sized}iameter-------------------------------------Depth-- Liquid Capacity--------------------- g privy: ! Distance from nearest well_____ ---------------------------_-----------._Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line___________________------------------------------------ ------- ------- -------------I---------------------- Remodeling and/or repairing (describe):--- -L �{� -------------------- -- •----------------------------------------------------------------- ---------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 'r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. --------- ------------------------(Qwnewwxd�°r Contractor) i Signed( ), By:......... ----------- -------------------------{Title}_ - - - - --------�atiion - --- (Plot plan, showing size of lot, location of system ' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DA ---` ----------- REVIE:WED BY-------------------------------------------------------------- DATE____ _ .. t ---------------- BUILDING PERMIT ISSUED--------------------------------------------------------- DATE ----------------- r _ ----------- ��f Alterations and/or recommendations:.___ _.__t__ _ --.- =-� -f--------- (510.0-11-- / T" ----------------------------------- ------------- 4-------- --- --------------------------------- FINAL INSPECTION -- - ------ -- ---- -•-- Date - SAN J QUIN L AL HEALTH DISTRICT 1801 E.Hamden Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street stockion,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9.59 3M 3-'63 F.F.CC. C ��