16866 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------- -------------------------- ----------------------------- (Complete in Duplicate) Da#e Issued --------- __.._..� -- 3rf -------------------------- This Permit Expires 3 Year From Date Issued ___ � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the woykhnreind�ibedThis application is made in compliance with County Ordinance No. 549,JOB ADDRESS AND LOCATIIO �N_I#7 Owner's Name------- .__ fir--------------------------•------ --------------------� Phone 1 Address------------ -- �_ r ....,t�j •-------- -------------•-------------------------------- Contractor's Name---------'11677 --' � � =--------------------------------------------------------------------------------- Phone Installation will serve: Residence gr Apartment House [-]' Commercial-❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _?__ Number of baths Z_-. Lot size _I`QC "-------------------------------------- Water Supply: Public system E] Community system [IPrivate 5RODepfh to Water Table ! ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ .Clay ❑ Adobe 93 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No JR' New Construction: Yes 2' No ❑ FHA/VA: Yes [tom- No ❑ 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-1/149--------Distance from foundation_-/49-----------Material-_�.________ __�__ ------------- No. of compartments---j-..............._.SizeLiquid depth-___�®_._._ P y Disposal Field: Distance from nearest well--j __ _.Distance from foundation-----�10.�.-__.Distance to nearest lot line__ _______ Lh Number of lines_______ ________---------------Length of each line---1AQ_'___.____-_--_.Width of french-.rx.-_____.__--_----.----_-_-__ Ir � Type of filter mate rial_ /E. ___ ____.:__Depth of filter material_____��.--__.___Total leng th________49 _ _____________________ Seepage Pit: Distance to nearest well_Xee___......Distance from foundation-_ Distance to nearest lot I•,e__47. --__-- + Number of pits-----•L_.__-._-----Liming material-- s-_.-.Size: Diameter__ '----------Depth_.r .0 iY.r___.__ Cesspool: Distance from nearest well----.---------_Distance from foundation--------------------Lining material---._-._----------__---_------_--_-__ ❑ Size: Diameter----------------- ----- -----------Depth-------------------\-------------------------------Liquid Capacity-------------------------- Privy: Distance from nearest well,_.:____�_---------------------------------------Distance from nearest building-------------------------..____-_._-_--._. 4 ❑ Distance to nearest lot line--------------------------------------------------------------------------- ---------------------------------------------------------------- J �,(r �F a Remodeling and/or repairing (describe)---- ----- ='-Gf��GF________�.t --------------------------•-------------------------------------------------------- ---------..•---------------------• --------'--------------------------------------------------------------------------------------•--------------------- ----------------------------------------------------------...... ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------ ------------------------------------ ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o the San Joaquin Local Health District.I (Signed)---------------------- - ---- ar ------------ - ------------ --- ( Py or Contractor) sn, showing size of lot location of.s stem in.relafio �wells,.buildings,..efc.,-,+ (Title)-- •------------- ---------- ------ - --- ----- - (Plot plan, s g ycan.be.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- ---------------------------- f DATE-------- ' REVIEWEDBY--------------------------------------------- ------------------------------------------------------------/----------------- DATE------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------—-------------------------------------- DATE-------------------------------- Alterationsand/or recommendations=-----------------------------------------------------------------------•--------------------------------------------------------------------------------------- --------------------------------------- ------------------------ -----------------------------------------------------------------------------------------------------•'-------------------------------------------------- ----------------------------------------- -- -------- --------------------------- --------------------------- -- ---------------------•-------------------------------------------- ----•--------------------------------.. ------• -------------- ----------------- ------------------ ---------------------------•--------------------------------------------- --------------------------------- FINAL INSPECTION BY:.. _ _..._-- --.. ----------------------- Date.-.__/' !_�-G- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasdton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca;California Tracy,California �' �E5f 9 REVISED 8-59 3M 3-'63 F.P.CC.