17798 - Laserfiche WebLink

Home Browse Search

FDROFFICE USE: -�..- r --__.._____..c .i---_--------- APPLICATION FOR SANITATION PERMIT Permit No. -.f..�7__.?__l�l� : -- ----. ....., . (Complete in Duplicate) ---------------- ------- ---------------- -------- 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. 54SI. 4 F i JOB ADDRESS AND LOCATION P ---- � Owner's Name-------- --�-•'----- - --f_-�"-��'-------=•-,._,.� .m=�::.__�--�:'=-=--=-------------- ------ ----- hone.__ ��__-c�l�l-- Address-----•------------- Contractor's Name---- Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ElNumber of living units: _C____ Number of bedrooms _3_-•Nurriber of baths J____ Lot size ___ ?._-____, _-/_P__ '---------------• Water Supply: Public,system W Comrnunit system y stem ❑ Private ❑ Depth to Water Table _(tea_ ft. Character of soil to a depth of 3 feet: I Sand ❑ Gravel [-]" Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: (If yes,date _________________J No New Construction: Yes ❑ No FHA/VA: Yes ❑ No 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 nearest well Nr7-!til ,Distance from'foundation---cP-'-------Distance to nearest lot line_________________ Number of fines---------_-� -- -----------------Length of each line----- '-------------Width of trench--------�--`�-•'-__---- ------ �"� Type.of filter. material - -----Depth of filter materiaL---.____/__rte"---Total length----------------- --------- r` Seepage Pit: Distance to nearest well__AX141�------Distance from on_ ati fours .-1P ' s d _ _ _ Distance to nearest lot line---- " Number of pits....... .t..----_--_--Lining materials-5. Diameter--__- -Depth---------- ---------- Cesspool: ----- --Cesspool: Distance from nearest wefl------------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter Dept = = ---------------- Liquid Capacity------------------------- 9als. - - ----- - Privy: ..Distance from nearest well------------------- _-____________. ---._Distance from .nearest❑ b0cling V%Distance to nearest lot line____ : -------- Remodeling Remodeling and/or repairing (describe):--------.-./)WW �` Xi,� �1V ' SYST[ `�� ------ ----------------------------------- -------------------------- t . ----- --- ----- ---------•--------------- =-------------=---b---- i------•------------------------------------•-----------_ :t ------------------------------------------------------ - ---------------------------------------------- - =-=------ --j -- •- -------------- --- - Ihereby I have ----------•-----------------------"----------------------------------------------- certify that prepared this application"end that the wor-k will be done in accordance with San Joaquin County f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------- C- 1-"� � ------ By �_- '- I , I : --------------------- ------------tl-------:------------------------------------- ner and/o� Contractor] By-------------- c�--- - '` 'r`•-A ' {Tale) of plan. showing size of, of, location o system in.relation to wells, buildings, etc., can be placed on reverse side). F 4 FOR DEPARTMENT USE ONLY l -APPL'ICATION"ACCEPTED BY___ I --------- ------------- ------F----- DATE--- REVIEWED Y REVIEWED .BY. ------------------------------ - ----------- -f ---- DATE BUILDING PERMIT ISSUED--- -.--------- ----------------=--------------- - t- r. DATE ----- Alterations and/or recommendations:---Q� -- '-•-------- CI ------------------------------ ------------------------------------------ ---------------- ---------------------- ------- l■ I __________-------------ti____________ ____________________ _______________ ------------------------- ------.----------.__.___________.__----------- FINAL INSPECTIbN BY.. _ �� .at �-,z/ +lo L SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stackton;California t Lodi,California Manteca,California Tracy,California ES 9 REVdSED 8-59 9M 3—•63 F.p,CD.