17756 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' � a --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .47.7------ _ ---------------------------- -- -V (Complete.in Duplicatel. _ . < , r,_ Date Issued ---- -• - ------,---------------------------------__-.._7 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 applicatir is made in co li ce with Coun Ordl a ce No. 549. . JOB ADDR SA D LOCATION.. -/ ` -' = ------ eM1 ____________________ Owners Name---:� t W C±--- ---•-....... -------------------- Phone . ! Address-----� _ �_.. -------- ---; •--------- - -----------•------------- ---------------•------------- --•-----•-----------------•----- ---...---•- - r � Contractor's Name--------- 4e- z.- Phone Installation will serve: Residence I] Apartment House ❑ Commercial ❑ " Trailer Court ❑ Motel ❑ Other j e Number of living_units:.---/-- Number of bedrooms __ ___ Number o rbaths ___ Lot size ._.=__ :. Y:.. -------------------- ❑ [I Water Supply: Public system, Community system Private epth to Water Table _.______ ft. i Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loarri ❑ Clay Adobe❑ Hardpan ❑ i C p ❑ I Previous Application Made: (If yes,dote-----------_--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (N septic tank or cesspool permitted if public sewer is available within 200 feet.) q Septic ank: Distance from nearest well__-*-'-------Distance from foundation-------Zo------- Material-`___ _________________________ No. of compartments----------Y:_---.-_sizef Dispos Field: Distance from nearest well._. �.�[lr_/_� -S� 0 e --Liquid depfh----.-- -�:----- ----Capacity---f---- i .! f ?_._._.-Distance from foundation-----/D---------Distance to nearest lot�ine_________________ Number of lines________________ ________Length of each line__-100--/_-f�-.__.---.Width of trench.____�:�_----_.-__________.- Type of filter material___�I,�_�___.__--Depth of-filter material____Ig ----------Total length_____ P_9__________________________ 'Seerm LPit: Distance to nearest well dQ_-�_._-.Distance fro undafion____fn..______.Distance�o nearest lomat lid- S_____. Number of pits-------I------------Lining material___ _ __ __ ___ -----Size: Diameter-------. ;E3 Depth-- Cesspool: epth-Cesspool: Distance from nearest well----------_------Distance from foundation- _______--___-_.Lining material _.._________--____.___--______.___ ElSize: Diameter------------- -----------------------.Depth---------------------------------------------` Liquid Capacity gals. S . Privy: Distance from nearest well-_---__________________________..__--__.----.-Distance,from,nearest building-----.------___________.______..__-. ---" -1 ❑ Distance to nearest lot line.-,----------------------------------- ----------------------------- ------------------------------------------------------------- Remodelingand/or repairing (describe):---------------------------- -------------------------------------------------------- -------•-----------------•----------------------------------------- LI r ---•-----------------------------------•------------•--------------------------------------------------•----------- -------••------------- ..-----------------:--------------------••------------------- ------------------------------------------------------------------------------------------•------------ ••------------------ ------------------------ ------------------------------------- ------------------ --------------------------------------------------------------------------------------------------------------------------- g 1 hereby certify that ive prepared this application and that the work will be done in accordance with San Joaquin County N I ordinances, State laws n `r les and regulations of the San Joaquin Local Health District. ' (Signed) --- ------ ---- ------- -----------------------------------------------------Y---------------------------- nd/or Contractor] , BY: -----------A�o, -----------=-- -------------------- ------(Title)--------------- . -- --------............... --- ------ (Plot plan, showing size of lot, location of system in rewells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-- ------------- - - DATE- _ —" ---------------------------- REVIEWEDBY----------------------------------------- --------- -- ---------------------,_/-------------------------------------------._ DATE------------------------------------------------------------ f BUILDING PERMIT ISSUED--------------- -------------- --------- -- --------------------------------------------- DATE -- Alterations and/or recommendations;---------------=----- ----�-------------- -- - 1 j = ----------------------- - = -=--------- ------------ - -------------------- ------------- -------I- : -------- R ' ---------------- FINAL ------ ----- ------------ -------- --•---------------- -------------- --••--------------------------------------------------------------- -------------------------------- ---------- ------------ FINAL I NSPECTION-'8Y:_._.- - .. '? - ,<' --------------------- Date------- ---------------------- ------- ----------------------- ------------. SAN JOAQUIN,LOCAL HEALTH DISTRICT 1601 E.Haxalton Avg. 300 West Oak Street 124 Sycamore Street 205 West 41h Street Stockton,California Lodi,California Manteca,California Tracy,California 3 E5 9 REVISED 9.59 31A 3-'63 F.P.CO.