17883 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---- APPLICATION FOR SANITATION PERMIT Permit No. .Z.7FoC3___ --- ------------- ------------------------------------ - (Complete in Duplicate)--------- --- -------------- bate Issued -------------------- ----------------- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JO1 DDRESS AND LOCATI N. -f�Li '?�_.�-- I� �t l l- `--i"�'?� -. ��-�--- I's Name-------------------17�--------- P�.G !----••- ----------•------------------- ------------ ------ Phone----••----------------••--------•--- �r Addr�llss-------------—� ��-- --------- 1y--- �� ------ � � :�. .--.--------------------------------- Y Contractors Name------------- y �- --••--------•-•----------- ------/—''t hone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ ' Ker Court ❑ Motel ❑ Other ❑ 1. Number of living units: _:L.-._ Number of bedrooms A---- Number of baths -I----- Lot size -r� ---------------------------------- Water Supply: Public system ❑ Community system ❑ Private,® Depth to Water Table /&17— ft. CharActer of soil to a depth of 3 feet: Sand E] Gravel-R Sandy Loam E] Clay Loam Clay E] Adobe C] Hardpan Previous Application Made: (If yes,date--------- ---------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE'!OF INSTALLATION AND SPECIFICATIONS: 1 Se (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tiI. oun Tank: Distance from nearest weII.Y�_�__ __Distance from fdation_-_/! Material---------------------------- _ ------ _-----..---_. p a II __----. � No. of compartments_._._,�r_________________Size_.: ..._--7--'I•-�___----Liquid depth--------� _ _.-_______.-_Capacity_£p-_____----------- I � . Disposal Field: Distance from nearest well_�.4?....:�._Distance from foundation____J___c_ ______._Distance to nearest lot __ _ Number of lines---------/------------------------Length of each line-----f-O----------------- Width of trench----- -d -------------------- Type of filter material 441_'_-etW_-Depth of filter material------- ?---------Total length-------60_--------------------------- Seepage Pit: Distance to nearest well--- _�_-___.-Distance from foundation---6__d_----------Distance to nearest lot line---- -__ Number of pits------ -------------Lining material__/,Vr-4/T------_-Size: Diamefer-- �. '._-._--_-Depth-_.2- ------------ Cesspool: Distance from-,nearest well --.,,__-- -._-Distance from foundation___--...-------------Lining material--.-_------.--------_-----..---------. ❑ Size: Diameter------------------- ------- Depth------- -- -----------------------------------------Liquid Capacity----------------------------gals Privy Distance from nearest well-------------------------------------------------Distance from nearest building---_--------------------__-----_--------. t. ❑ Distance to nearest lot line-------- --------------------------------------•-------------------------------------------------------------------------------------------- `T RemcLeling and/or repairing (describe):------------------------------------------------------- -----------------------------------••-----------•------------------------------- ---------.----------------------------------------------------•----•------------------------------------ 3 - - --------------------------------------------------------------------• ------------------------------------------------- -- ------------- ---•-------- --------------------------------------.._..---------------------------------••---------------------------------------------------------------------------------------------------------- S P 1 I. hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County G ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ]] P (Sign 8d)----- � - ----- ------- -------------------------------------------------------------------------------------------(Owner and/or Contractor) By:---------------•------ --... -------------------------------------------------------------------------{Title) .: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ow i FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY-- ------------------------------------------------------ DATE---- '__. _' -__ ._ REVI1WED BY------------------------------------- --- - ----- ------------- -- ------------------------------------------------------- DATE------------------------------------------------------------ BUILOINGPERMIT ISSUED-------------- - --------- ------------------- DATE- - ----------------------- ----------------------------- 4 ►. Alterbtions and/or recommendations. ----- - ---- - - -- ------1` - --------��f ' ------.0 - --------9- +�' F I I ---------------------------------------------------------•---------------------- ---------------------•------------------------------ -•----- -------------------- --- ----------------------------- -------------- FINALw INSPECTIONBY:.. ------ -04-41; -�------------------------- Date-. ------------------ -------------------------------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ay*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REvISED B-59 31A 3-'63 F.P.CO.