17444 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------_---------- ------------------------- 17 � �Y --_-_______----_--__-------------------_---- APPLICATION FOR SANITATION PERMIT Permit No. ._ ....._ __...._ ----------- --------------------------------- (Complete in Duplicate) S (� - Date Issued --------------------------------------------------------- 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. ' JOB ADDRESS AND LOCATION------....L5--- �- r� � Vf .. Owner's Name ` = ,-------------------------- - -- -- Phone--- Address zG1. ---- Contractor's Name---------------- .. -c_ U� ---------- Phone. Installation will serve: ResidenceApartment House E] Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: ...((-___ Number of bedrooms -_____� Number of baths ----L Lot size ------- `�&Jd.d-•---------------•----_-- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table 1_$. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamn Clay [ Adobe❑ Hardpan Previous Application Made: (If yes,date--------------------) No New Construction: Ye No E] FHA/VA: Yes [I No` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d Septic Tank: Distance from nearest well ! {�is�# e from foundation-----&.........M to ial_! •.. _-__•__-- _: � No. of compartments------i�---------_•-._..Size. :� X_ X__ _,___Liquid depth__.. _lY .____.Capacity__I��po_;'�"._ s Disposal Field: Distance from nearest well.A _.'7.l�st+ ante from foundation.14 Distance to nearest to li -S — Number of lines---3. ___.__Length of each line_�7-1 am/.. ...Width of trench ".r_ ----------------------- Type -_•___-____--.--. C Type of filter material._/_:_____.. Depth of filter material-----fSL._-_---_-_Total length--------- ______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_--__._-__-____-_ ❑ Number of pits......................Lining material-----------------------Size: Diameter----__.-.-.__.-__.--__-Depth_.-.-.---.-___-______--._-__-__- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------.---._-____.._-__-_____ ❑ Size: Diameter--•------ -.-_-.Depth------••--------•----------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well----------------------------------__-------------Distance from nearest building----------------------_............._-_--. ❑ Distance to nearest lot line--------------------------------------------- ----•-----------------------•--------• ------ Remodeling and/or repairing (describe):--------- -?x= x-°�=-___�______I__`�_____��_�¢_--1.;��--.__._ -------------------------------------------------------- --------------------•-•---------•-----------•----------------------------•------•----------------------------•-----------------------------•---•--••-------••----------------------------------------------------------------- W ------------------------------------------•---------------.•--------------------------•--.---------.---------_----------------------------------_-----------------.----------.-----------------.------------------------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, /State, S, an rules and r c�ulations of +he San Joaquin Local Health District. (Signed)------- — __ ` -1 2J ------ ------ --- ----------- --------- -------------- - -------------- ----(Owner and/or Contractor) Br<< (.f......� r. - --------- ------_- ----=-_------------------------------------------------(r+le) - _.. - (Plot plan, showing size of ►ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------- ----------------------------------------------------------•----• DATE------------------------------------------------------------ REVIEWEDBY------------------------------------------------------------------ -- •. DATE--------- ------------------- BUILDING PERMIT ISSUED-•------------------------------------------------------------------- �',/=_- -----. DATE-----`' =1 ----------------------------- Alterationsand/or recommendations------------------------------- --- ------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ...........................------------------------------------------------------------------...----------------------------.......------------------------------------------- ----------------------------------------------------------------------------------------------- -------------------------------------------..............................JL-------------------------------------------------- --------------------------------------------------------------------- ---------------------------- ------------------------ ------------------------------------------•-----------------------------•----------- ------------------------------------------------------------------------ ------------------------ ------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY: _ _ Date ------------! r? - — SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 96 9 REVISED S-59 3M 3-'63 F.P.CD.