20054 - Laserfiche WebLink

Home Browse Search

FOR`OFFICE USE: - -------------------------------------------------------- _._._..----------------______.---_.-----------------.If:-- APPLICATION FOR-SANITATION PERMIT Permit No. 4 _. 'If . 6 (Complete in Duplicate), hI This Permit Ex fires I Year From ®ate Issued Date Issued Application is hereby made it the San [[Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in cc. pliance with ounty Ordinance No. 549. SO-0 JOB ADDRESS AN A ION.It� -e-s-- -------- r------- O--moi Owner's Na ------------------ - - Ph -------------------------------- - t r�r --- -- one Address ..... ��< ........ •---------- i Contractor's Name------------ -- --- - --------------•--------•----•------ �-------------•-------- - --------------------------------------------- Phone....•--•--•-------------•---------- Installation will serve: Residenc A artmenf House Commercial ❑ .Trailer Court ❑ Motel El O�n' ❑ ` Number of living unitsfl1__�.____ Number of bedrooms ,_.Number of bafhs -_ ___ Lot size _________ Water Supply: Public system[ ❑. Community system ❑ Private ' Depth to Water Table 7_557. ft. Character of soil to a depth If 3 feet: Sand El Gravel ❑ Sandy Loam El Clay Loam El Clay El Adobe C] Hardpan E]Previous Application Made: (If yes,date--------------_----) No ] New Construction: Yes N° FHA/VA: Yes ❑ N 671— 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____ .___9Distan r o nda{1 -_ _____.Ma No..of co� artments-- p -�-------------------Size_ /�� _: Liquid depth---- - -'-..Capacity... _ '_'_ Dis aI Field: Distance from near st well-S.0__..__Distance from foundati n_ `!-__._.Distance to nearest lot 1'ner��_5 ----------------- Number of lines___ __________ Length of each line________1"J_ {l.Width of trench.__ ,. Type of filter.material_c)-[-.,�__._ >?'�'Depth of filter material__ `______Total length-------- ___6__________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number olIf pits----------------------Lining material-----------------------Size: Diameter------------------ ----Depth--------------------------------- Cesspool: Distance�from nearest well___________ __Distance from foundation---.----------------Lining material---------------------------.,--_____ fl f ❑ Size Diameter--------`------------------------- ---Depth----- - ---- --= ------ - --Liquid Capacity-. ------------- -----gals. privy: w"'"D�stance from neared well__ ___________ Distance . rome`sfi,building `El Y Distance to nearest lot line-- ---------------- --- ---------------- ------------------- - ---------------------- - ---------------•---------------- Remodeling and/or repairing '(describe) - x --' ------------------------•-------•---------------- ------------------•----•------------------------q�.----------------------------------------_-------------•---•----------------=-------------•-----------:-------------------------------------------------------------------- 7--------------------•------------- ------------------------------------------------------•-----------------------•--••------------------------------------" 4... •----------------------------------------•--------.-------------- •--------- ------------------------------------------------------- ------------------------ ---- I hereby certify that I have prepared ' application and that t ork will be done in accordance"with San Joaquin County ordinances, State laws, and rules and re tions o A San Joa oval Health District. 5(Signed)•- = --•------ -- -------- ---- --- --- -------- ---------------- -------=---------------------------------------(Owner and/or,Contractorl By:--------------------------------- --------------- - --------------------- = ---- {Title) _4�_ (Plot plan, showing size Of,lot],IIlocation of system in relation to wells, buildings, etc., can be placed on reverse side). � FOR DEPARTMENT USE ONLY 5 APPLICATION ACCEPTED BY - - ------------------------------ DATE , REVIEWED BY ---------------------- DATE BUILDING PERMIT ISSUED ��t' •-------------------------------------------------- - -----------------/----- e- A*TE ----------------------- ----------------------------Alterations and/or recommenattons:--------- -- -------------------------- -------------�---- --- -------•-----------------•------ ' .f ---•-------------•---- -------- --------------!I-I.-- -------------- ---------------------------- --------- ------------------------------- ------------------------•-----------• ---------------------•----- --------------------------------------------------------- -----•------------------ --------------------------- --------•---- --------------------------------------- -- --- --------------- ---- �� -------------------•----------...---------------•-------------------- -------•---------•-----._.-------------------------------------------- ---------------------, ti FINAL INSPECTION BY---- -----------------•---- ----- - ---------------------------- Date-------- _"' ` SAN JOAQUIN LOCAL HEALTH DISTRICT }. 1601 E.Ma:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California C5 9 REVISED 8-59 3M 3-'63 F.P:CD. �i