21806 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------=------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ------------ --- ------------------- -- (Complete in Duplicate) _, _ _�. ....�. - -�- 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 Ordinan o. 549. `�= y "t'�y •-----------------"--------------•------------=--•-•----- JOB ADDRESS AND LOCATION... ._. ---------q------- --- ---- -- ------ Owner's Name------------------A_ �-------- I----- --------------- ------ Phone _�1--Zak?--- Address----------------------------------- � am t - - ----------.:--Contractor's Name ........•-----_-_ ----•-- _9_a Phone---------- -9 Installation will serve: Residence 2--Apartment House ❑ Commercial ❑ Trailer Court ❑ •Motel--A --Other ❑ Number of living units: ---J__ Number of bedrooms Z, Number of baths _J... Lot size .__-.° -l— Number Water Supply: Public:system ❑ Community system ��vate ❑ Depth to Water Table _/Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ffl---*Hardpan ❑ Previous Application Made: (If yes,date___________________) No Er---New Construction: Yes e No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,�Ibue (✓ , ,u F :(No septic tank or cesspool permitted ;f public.sewer is-available within 200 feet.). Septic Tank: Distance from nearest well-_30-0 Distance from foundati 'Q-__f . . ____--Material___ R -__.-_ No. of compartments---------9_--_._____1W Size___ /M squid depth_:_41�__._______Capacity. + ( __.___ T ' Disposal Field: Distance from 'nearest well_._---Distance from foundation._1�_.___.____-Distance to nearest lot line____a5._____--_ Number of lines-----------(-_____---___________Length of each line---------! __._________.Width of trench...... �__ __------ --____ Type of filter material___2�_ -Depth.of filter material_____`------------Total length----------_Y_------_____________Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____________._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------. I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining - _ _. material_______-______.__.__-____________._ Size.: Diameter--------------------------------------De th_ ------- -----------------------_Liquid Capacity ---:----gals. Privy: Distance from nearest well-------------------------------------------------Distance from,neares building --- ------.____-___---______..____... ❑ Distance to nearest lot line--------- -----------------------------------------------------------•--------- ------------------------------------------------------------- Remodeling and/or repairing (describe):----------- ---------------------------•---------------------------------------- -----•---------------------------------------------•---- -------------------------------------------------------------------------------------------- ------------•----------•---------------------------------------------------------------------------------------=------------ ---------------------- --------------------------- ----------------------------------•---------------------------------------------------------------------•------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat�1 , d rules d regulations of the San Joaquin Local Health District. (Signed] ---- t ------------- -- -------------------------------------------------------------------------------------(Owner and/or Contractor) 77 = t - a _ - �'"�'-(Plies-plan, showing siz of-lo+,lo'cation of,sysfem relation to wells, bu II dl^gs, etc., ccn be-placed on r verse side}.4 . FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY'�. _ -��S__- DATE _- i - - --- ---------------- ---- --------------------------------------------- DATE-------#�__--- ---- -- - REVIEWEDBY---- -------------- -- ------------------------- ----- DATE BUILDING PERMIT ISSUED- ---------------------------- --------------=------ ------------------------------------------ :. DATE Alterationsand/or recommendations:.------------- --------------------•--------------------------------------------- --•--•--------------------------------------------_-------_--- ------ ------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ----------------------------_-----------•---------- ------------------------------------------------ ----------------------------------------------------------- ------------------------------------------ ---------- ---------------------------------------------------------- I /' FINALINSPECTION - ---- --- - ------ -------------- Date..---------- = ------------------------------------------- N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street )Stockton,California Lodi,California Manteca,California Tracy,California r E6 9 REVISED 13-59 31% 3-'63 F.P.0 C. f }