16859 (2) - Laserfiche WebLink

Home Browse Search

---------------- --------- --------------------- _____- APPLICAT)�N FOR SANITATION PERMIT Permit No, --------- ---------- . - (Complete in Duplicate) . f1 --------------------------------------__--__-___.__"._.- ,This Permit Expires 1'Year From Date Issued 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. 4-1171-11 1 r JOB ADDRESS A D LOCATION '�-�""[' `= '`" _ - Owner's Name, :` ------__`L �1 �� .. amt------------- ----------------- ---------------.-. Phone------------------------ Address Z' -1� � ^ ��_ l1 _----- ----- ----------------- Contractor's Name------ --- Phone------------------------••--------- f'. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I__-- Number of bedrooms _ Number of. baths -_ Lot size ___________.-._-___ Water Supply: Public system Community system E] Private ®/Depth to Water Table _---____ ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El. Clay El Adobe El Hardpan at Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑j TYPE OF INSTALLATION AND SPECIFICATIONS: 3 (No septic tank.or cesspool permitted if pu61ic sewer,is available within 200 feet.) Septic ank:. " Distance from nearest well_A�--r-----_Distance from foundation_.-__1_U__f_-.- Material---f4�zZk-E'er_____________________ �� - S or ! No. of compartments------. Sizef-t•-� �� --- Liquid depth--- -Capacity Disposa field: Distance from nearest well. Q__ .-_Distance from foundation.___/_,6_!------Distance to nearest lot line'____________ Number of lines----------- -------____ Length of each line-----/Q�-.........__-------Width of trench....... j__._.____.-____-___ Type�of filter material_ t_.___ .. Depth.of filter material"__--t _�_____-_Total length_____ �-�________________________ - s'L r ► f a See pa Pit: Distance-to nearest well-------I'00------Distance from foundation____f d_.._.___.Distance to nearest lot line_____-_____ R Numlaer'of pits___________ ___________Liningmaterial�&L.'� ------Size: Diameter-------- Depth---.�-tS_' ____-_______. . I Cesspool.• Distance fi•om nearest well-----------------Distance from ❑ foundation_--_.:___-____---. Lining.material________.___------------------_---__ Size: Diameter---- -----------. "-I----------_4De th-------------------------------------------------- Liquid- Capacity gals.. _ — Privy: .. ,,. - ; Distance from nearest well_____________________________________--_-_--Distance from nearest building_----_____-_-___- ❑ a . _ ----------------- ---- " Distance to noarestlot'lin�__ _"--------------------------------------------------------------------------------- - - - Remodeling and/or repairing (describe:--- --------•-------- - `j}` ------=-------------------------•------------ i I hereby certify'that I have prepared this:application and that the work will be done in accordance with San Joaquin County ws, and rules and regula�ionsl of the San Joaquin Local Health District. ordinances, State '� "r� - "` '-------------------- - `"-ter -^._.(©WfSST"und/or Contractor (Signed)----------- .� I Plot plan, showing size of lot, I'o ation of s s�tefn in ela ion to wells,""bui1-d- s, Qtc.� (Title)-----------_________-------_____ 1 y ( P g y g can 6e placed ori reverse sidel. _ r FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY---- +t d.rt: ----------------------------------------------------------- DATE--- ly----------------------------------- REVIEWEDBY------------------------------------- --------------- ------------------ -------- ------------------------------------- DATE------------------------------------------------------- BUILDING ---------------------- - -BUILDING PERMIT ISSUED = 'DATE------- -------------= - = -- --------- LL Alterations~and/or-'recommendations: .-______._ '�. - ------------------------------___-_-_---- ! 1 fi i- . ! . r F y ______________________________________------------------------------------------------------------------------------------------------------ _1 _ __-_-_.___._-__-_-_ ___---____-_-.-_-- __.___-_ T , _4 t --------------- ------ ---------------- - - -- ------------------------------------------- ------------------------------------------------------------------ ------------------- ------- ----------------------------- FINAL INSPECTION BY: Date----- ` , c `'(' r'---- --- -- ---- -- ---- - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon AV*. 340 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Cra 9 REVIBED 6.59 3M 3-'53 F.P.CD- ".