18918 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------- ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___/S_1,/1, ------ ------ --- -------------------------•--------- (Complete in Duplicate) S Date Issued ____________________________________________ This Permit Expires I 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. ' r ,�_... .�., JOB ADDRESS AND LOCATI N . . _, � --- �?s��o G Owner's Name---�=-t------ -_- --------------- ------------------------------------------------- Phone--------------------•-------- I?ZAddress............ t---- ° ------------ Contractor's Name__.t t -----•--------- ---- Phone---------_------• •------------- Installation will serve: Residence TJ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1------ Number of bedrooms -.3---- Number of baths 1.----- Lot size ---Otq-&-4-c----------------------------------------- Water Supply: Public system ❑ Community system ❑ Private R Depth to Water Table Ao_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam a Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date__.----------------1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ W 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-----------------Distance from foundation--------------------Material______..____._____-_____._____ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity_---------------- --/ Disposal Field: Distance from m nearest weal_,_"'___'_Distance from foundation-A ---____._-_Distance to nearest lot line_e_Q'_._____ ,r'] Number of lines-------®------------------..-___ Length of each line------1 --------------Width of trench----- 'q_t'------------------- Type of filter materia_ 4F-_Depth of filter material.-._-_0_''_-------Total length--/47P--_--:------------------------- i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-.______.____-_ ❑ p -- 9 ---- ----- p ---------------------- Cesspool: . Distance from nearest well-----------------Distance from foundation---,------------- Lining material--------------------Number o its__________________ _ Linin materia_____...__._.... . Size: Diameter___-,_-__.-__-._ Depth- ❑ Size: Diameter--------------------------------------Depth--------------------------- ------------Liquid Capacity--- -------gals. Privy: Distance from nearest well------------__________________________________Distance from nearest build-rng.__.-_.--._-.----_-----------._-_.--_--._. ❑ Distance to nearest lot line----------------------------- ----------------------------------------- --------------------•-------------------------------------=_---------- Remodelin and/or repairing (describe): - 1 9 / P g I I �A�t -9'�- t. ',_—t -----tf--------------------------------------------------------------- 47 ----------•----------------------------------------------:----------------------------------------------------•-------•-------------------,------------------------------------------------------------ ---------------------- -------------------- ---------------------- ------------ -- -------------------- -- ---------------------------------------=--- ---------------------------------------------------•------•----------------------------- ----------•------•---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules and regulations of the San Joaquin Local Health District. c14 r 4A - - -- -----------------------------------------------------=--------------------------------------------------(Owner and/or Contractor) "-_= --=E_---- ------------ =_ - = Title — - r - . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -'z'` -------------------------------------------------------- DATE-,$---Y:'6S—--------------- ------------------- REVIEWEDBY--------------------------------------------- ------------------------------ DATE-------------------------------------If BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------- ------------- Alterations and/or recommendations----------------------------------------------- ----------••-------- ---------------------------------------------------------•------------------------------- ------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ----•----- ----------- ------ -- ------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- FINAL IN .. SPECTION BY-- ---------•---------------- Date--- -------------------------------------------------- SAN -------------------------------------------•--- 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 ES 9 REVISED B-59 3M 3-'63 r.F+.Ga. �I