19345 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ; `• --------------------------------------------Z ••------- APPLICATION FOR SANITATION PERMIT Permit No. --ey3_- � --------•---------------------------- -------- ------- (Complete in Duplicate] f ----------------------------------------------------------- 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. 549. JOB ADDRESS AND LOCATION = ,----------------- ------------ - _ ��G' ��..._ ______________________________________________________________ Ph ---------------- --------------- — Owner's Name •-----------•---•-•-----......-•• �� _c_L`� Phone -� --- Address---- ----y--` t - (-------------------------•------------••---------------------------------- --------------------•- Contractor s Name_______,_ \� ____..___.:---__._ i Installation will serve: Residence [ partment House ❑ Commercial [) Trailer Court ❑ Motel ❑ Other ❑ Number of living units: l Number of bedrooms -_-/._ Number of baths _/___ Lot'size ---- _!______'_1 �__ v _____________ Water Supply:I . Public system--CommunitY system ❑ [-]s Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----_-------------) No Construction: Yes ❑ No 1 HA/VA: Yes ❑ No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: ! f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' E Septic Tank: t Distance from nearest well ____ ----------Distance from foundation---------------------Material------_.____.---------.-----------__------------ ❑{'` No. of compartments.. - ------------Size--•------------------------.---Liquid depth------------------ Capacity Disposal Field: Distance from nearest well________________Distance from foundation.__._..........-----Distance to nearest lot line_--___--_.______ ` jNumber of lines----=------------------------------Length of each line----------------------------_.Width of trench----------------------------------- Type of filter material-------------------------[depth of filter ma#erial-------.-----------•-.Total length-----------------:---------------_-------- See age Pit:, Distance to nearest well---._------------------Distance from _f�of�u,ndation____________________Distance to nearest lot line_______.______-- {ld� __. Number of pits. ,}_,. 4_-_.-----Lining material---1d- Aize: Diameter_ - ..__.....Depth------P___._________________ ` r Cesspool: Distance from nearest well----------------- from foundation____.------------- Lining . material___._______________________________- ❑ Size: Diameter- ----_-_- --' -----.----De th--------_---_-------------'---'-------------------'.Liquid Ca acitY ---------------------r__gal,, -VN Privy: Distance from nearest _ _ well_________________________________________________Distance from nearest .building__.________________ _________.__..__ __- ❑ Distance to nearest lot line---------------------------------------------------------------- -- C ---------------------------------------------------------------- �rair s�c_.czL. Remodeling and/or repairing (describe): ' :` "e et�� c=----------------------------- t---`f -------- - -�1-rG�)- t/u rE —�r — f - ---------------1 --• --------.....`��-- -----------=---------------------- ------ ------------- ------------------------- ----------------- ----- ------------------------ --- - -- F I hereby certify that I have prepared this application and that the.work will be done in accordance with San Joaquin County ordinances, State laws, and rules and-regulations of the San Joaquin Local Health District. (Signed) y--------------------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) -------------------------------------------------------------------------------(Title)------------------------ --' '- -' ---------- (Plot plan, showing,size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ __ � i ---------------------------- DATE---------------- REVIEWED BY--------- ------------ ----- ------ DATE- ---'------------'-------';-----------'-----'----------------- -----------------•-------------------------------------'-' BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------- DATE----- ------------------ ' Alterations and/or reco endaf'ons;r_._ -------------------------------•----- A' - - --- -- - -- - - - --- � -- ---- - ------- - - - ------------- F " --- --- - --- ------ - -- ----- ------ --------- - - - r ---- --- " Cir/" ( -- - - f -- - FINALINSPECTION BY----------- ------ -------------------------------------------- Date---------------------- ----'----•----------------------------------------------- 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 E5 9 REVISED B-59 3M 3-'63 F.P.cu.