16906 - Laserfiche WebLink

Home Browse Search

/FOR OFFICE USE: / r -� ---------------------/a--'3 Permit No. APPLICATION FOR (SANITATION PERMIT _ ------------------------------------------------ _ ------------------------ --------------------------- (Complete in Duplicate) Date Issued-_____� .""_G/ ---------------- ------------- --- --- -__.-_- This Permit Expires 1 Year From Date Issued , Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. t9 JOB ADDRESS TD LOCA�TIO�N___1---_ ----�-- --------------------------- ------ - ---- Phone-------- ---------- elf, r------------------------------------------------ ' Tf - - - -. Owners Name- -g--... -- Address-------- v -----��. --------- ---------- --• --------------------------------•--------•------------------.._..--------------------•---------..__.....------.. Phone---------------------- Contractor's . -----••---••-•-------- Installation will serve: Residence Apartment House ❑ Commercial [3 Trailer Court ❑ Motel [3 Other [j l Number of.living units:_ --_ Number of bedroom .Number of baths. Lot size.----7j_x---47� --------------------- Water Supply: Public system'❑ Community system'[:] Private [B— depth to Water Table ft. + is Character of soil to a depth of 3 feet: . Sand Gravel El Loam El Clay Loam E] Clay ❑ Adobe❑ Hardpan C3 Previous Application Made: (If yes,,date--------------------) -No New Construction: Yes K3--No E] FHA/VA: Yes ❑ No [�- i TYPE OF INSTALLATION AND SPECIFICATIONS: ' - I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic ank: ' Distance from nearest well_______________Distance from foundation--------------------.Materia---------- --------------------------__ ____. �No. of compartments----- ---------Size-------•-------------.------ ---Liquid depth---;-----,! --------------Capacity--------------` _____._._Distance from foundafion_.A�.-.___--""-Distance to nearest lot line__0---------- Disposal field: Distance from nearest well--- Number of lines------ --------------------------Length of each line-----_7,5........---- --Width of trench----��-_5---------------""-"-- Type of.filter material-- I -___--___=Depth of filter material__t�_ _________:Total length------ ,��_________________________ Seepage Pit: Distance to nearest well_____.':'r'7' Distance from foundation__________________.Distance to nearest lot line_____-._______--_ Number of pits----------------- ---*Lining material----------- ----------.Size:-.Diameter"" Depth S Cesspool: Distance from nearest well__ ____"'"'Distance from-,foun�dat n__.---------`-----.Lining material__-____�___________________________ Li uid Capacity --------------------------gals. ❑ Size: Diameter# ------ ----------- Depth-------- ----•---- ---------------------- 9 p Y Distance from.nearest.building Privy: Distance froin nearest well---------------------------------------- -------------------------- ❑ Distance to nearest lot li -------------------- + � { F ti a- Remodeling and/or repairing'(describe)----- ---- ---------------------------------------------------------------------- foe --- ----- -•--------------------- rf. ------------------ ------------------------------- ------------- -------•------------- -- I I, :. ---•-------•-----------••-------•------- ----------•------------------------- --•--------------------------------------------------------=-------- ---------•-------------------:------ 13F I i hereby certify that l r pt ared this app ati nand at the work will be done in accordance with San Joaquin County ordinances, State. laws, and rules and regulations of- t San aquin Local Health District. caner and/or Contractor) (Signed)' By:---- --------------------------,. Tttle _ __ g ; - ----- --------------- ( ---------------------- ------------- ------------- ----------------- - ----- -- ---- - -- (Plot plan, showing size of lot, loca ion of s em in r 1 on to wells, buildings,,etc.,.can be placed on reverse side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-.-------• :7 (� REVIEWED. BY--------------------------------- -- ----)-- -------------------------- DATE BUILDING PERMIT ISSUED------------_ ------------------------------------------------ DATE ` Alterations and/or recommendations------------------------------------------------- ----•-----•----------"""--- -"""-----"""" -----" ---------------------------------••------------------------- ------------------------------------------------------------ -------------------------------------------------- --------------------------------- ----------•---------------------------------------- / . FINAL INSPECTION BY: [�l/ ------- ----- Date 1 SAN JOAQUIN LOCAL HEALTH DISTRICT s 124 5 camore Street 205 West 9th Street 1401 E.Mat:elton Ave. S 300 West Oak Street Y Stockton,California t Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P-CC.