17614 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: /;7 ------ � � - ------��-------�� -- _ .:; . . _ -� ----....----- -• SANITATION PERMIT --------- ----------- -------------------/,j? Permit Na. APPLICATION FOR -.------------------.---- (Complete.in.Duplicate).. _ w Date Issued is hereby made +o the San Joaquin Permit Expires 1 Year From Date issued ------ -- Application y ' oaquin Local Health District for a permit to construct and install the work herein described. s This application is made in compliance with-County Ordinance No. 549. I , �j nn_, JOB ADDRESS AND L CATIO °Z /L'---..£l--=-- .: ------- -----:- --------- - •. Y Phone Owne'r's Name-- ------------ ------------ ---- ' 1:11-a -------------•------------•------- 1 Address------ ---Z:" { ----------------------------------- Contractor's Name-----... --- �J .-- •----- - -----------'-•--------------------------'---- Phone. ---- --------------------= - - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other r-=� i Number of living units: __.r___ Number of bedrooms _ ate ber ©ebaths --/--_ Lot size =• Q - ____-- - Water Supply: Public system .Community system ❑ T-1p Water Table _ _ ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: .(If yes,date------------------ } No New Construction: Yes [�r'_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 T nk: Distance from nearest well_____-~-___._`Distance from foundation_____- _.___-.Mate`'sal___I_-�`_________________________________••. I No. of compartments___=: .--------------- -__Capacity__'�'r>q- I _ ------Size K Liquid depth__._.. 11 ' Disp�os/al Field: Distance from nearest well _'.._____Distance from foundation-__��-------.--Distance to nearest lot line____-___ -- 4 l-7 Number of lines: __�----------------------------Length of each line---9"901--------- --------Width of trench_.__ - -- --.------------- ` Type of.filter.materiai__�l- -°C-�r--___-___=Depth.of filter Material__/.�"- ._______Total length___._ __ ___________________/_.____ r ,�1 ____Distance from foundation_ b________.__.Distance to neares+ lot line__ _�_..---__ Seepage Pit: Distance'fo nearest well-____ _______ 1_ Number of pits_I---�----------Lining material------/- - �_�j. Size: Diameter____3 __`-_..____Depth__._-' ' ---------------- .J f Cesspool: Distance from nearest well_________________Distance from foundation_____________:_----.Lining material__._----------------------------als. ❑ Size: Diameter- -------------------------------- Depth----------------------------------------------- Liquid Capacity g r -------------------------Distance from'nearest building-----------------------•------------------ � privy; Distance from nearest well______________________ Distance to nearest 3lot.line_____________________°. ------------ Remodeling and/or repairi ---•---------:---- -- r ------- ---- -------------------------------------------------.-------------------------------------------------------- 3 ng (describe)---------------------------------- t - ! t ---------------------------------------------•---------------------------------- -------------------------------- -------- - ----------- ---------------••---------------------•---------------------------------------- [ I.hereby certify that I have prepared-this applica+ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. ` S �or Contractor) (Signed)----- ------- = ----------- ----- ------ --------------------- BY -------------_.-:----------------------------------------(Title)------------------- ----------- ----------- ------------ (Plot plan, showing size.of.lot, location of system in relation.to wells, buildings, etc., can be placed on reverse. side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- = <- -------- DATE-------7_77/ - --------------------------- REVIEWED BY---- --------------------------------------------------- ------------ ---------- --- --------------* ---------------- ------ DATE---------------------------------------------------------- - DATE.---------- ----------- -:--------------------------- ( BUILDING PERMIT ISSUED----------------------------------- -------------------------------- --------------------------- i^ Alterations and/or recommendations:----------------------------------____ f = -------------- -------------------------- ---------------------- ---------------------------------------------- =- ----------------------------------------------- ------------------- 7- -2 . INSPECTION BY:.___.._�------- `-°1---. ----------- Date------ --------------------- FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Koxelton Ave. 300 West Oak Street 124 sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REv15E0 8-59 3M 3-'83 F.P.CO, i a-