16206 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .__l_Ia-��- -- --------------------------------- a -.?I_fl6 3 Complete.in Duplicate) „-.____---_- 4 This Permit Expires 1 Year From Date Issued _._.. - -------- r ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ie in p' e'with County Ordinance No. 5 49. yT (77 � -- -----•- JOBADDRESS ANb ATION--- ---- - - Owner's Name------ ------- ---- --------- - ------------------------------ Phone .- opa ---------- ------------------------------------------------ -------- -Address-----•------- -------------- -©------ ------------ Phone--------------------••------------- 1. Contractor s Name----------------------------------- ----- , Installation will serve: Residence A artme ouse Commercial ❑ Trailer Court ❑ Motel ❑u O her ❑ - p ❑ g --S,'/Number of baths ---L Lot size ---1 1 ...... -------------------•--------• ---=--------- Number of.living units:.--..-----Number of bedrooms 1 Water Supply: Public•system ❑ Community system ❑ Private Depth to Water Table ,l 7 t• ' Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ . Clay Loam [I Clay ❑ Adobe E' Hard No ❑L Previous Application Made: (if,yes,date__.___._-,-__._-.) No IR New Construction: Yes � No ❑ FHA/VA: Yes E] ,LTJ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 2U0 fest.) _. _ _ Septic Tank: Distance from'nearest'well:..-$�J ''rDistance�fr •�foundation_-----------.__.Materi�l• rr • __Capacity.... �w .No. of compartments--------�_ .��Ize��--- ---X.__1�----Liquld depth_-----��/- Y"1 � 1 - pp Disposal Field: Distance from nearest well.e--,�----Distance from founds ion__._�---l---------Distance to nearest lot line__.__ 7 Q- _7_`70clth of trench----- _ -- Number of lines--------` - Length of each line-- _ fr 1 R Type of filter material-_�`_� -0epth of filter materiaL._ ------------ Total length------ �-----------=------ - I Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El ,Number of pits..: ------Lining material---------- ------------Size: Diameter Depth Cesspool: Distance from nearest well____.__.__-__.__Distance from foundation-- __-..-.--.__..Lining material---------------------------------- __ Size: Diameter---E---- ---- - ------- ----Depth----- -------------------------------- El. --- --- ---------- Liquid Capacity-- ^, ❑. - _. ,� - .,� Distance fromest building--------------------------------6-----------I`-A\ 9 �. _. !,. - �. Privy- Distance from nearest well ---- -- --- ------------- l Distance to nearest lot line--------------------- -------------------------------------•----•---------•------ j -:: ------ � ---------------------------------------------------- ------------- ---- --- ------ tYi[��`: D�CQ�1J-- �' l ---: --- ------•V--•- :k -----------------------------------------------------------=--------- : done ! her ebytate tlawshaandhave rulespandareguI tionp olf the San Joaqui the L cal Heal heDistr ctn accordance with San Joaquin County ordinances, S (Owner and/or Contractor) (Signed). ` - -- ---- -- -- [ le)---------- ---------------------------------- By: ------=------------------------- --- .. [PlotYplan, showing size-of lot, location_of_systemTin,relation,to_w.ells,-build'tngs&e+c;.can-be-placed-on reverse side). FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY-------- ------------------------- ------------------ -------------------------------------------- DATE-------------------------- -------•------------------------- - REVIEWEDBY---• --------------------------- _------------------------------ ---- - -- DATE--------DATE------------------------------------------------------------ -- BUILDING PERMIT ISSUED--.------ ---• ------ ----------------------- - --------------------- Alterations and/or recommendations--------------------- --- ---------- - -------------------------------------- -;---------------------•-----•--------------------------------------- j ------------•--------•---- -------------------------------------- 1 ---------------------------------- ------- r1 .. Date.....-- - FINAL INSPECTION BY:.--- ------------------------------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. r 300 West Oak Street Lodi,California Manteca,California Tracy,California Stockton,California _ E5 4 •'63 F.P.CC- REVISE(? a-59 3M 3