17489 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------- - ---------------- (Complete in Duplicate) ---.... This permit Expires 1 Year From Date Issued Date Issued___?7=_ ' - 00.5-- leen—t�!o Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in described. This application is made in compliance with County Ordinance No. 549. jzF�rY try O JOB ADDRESS AND CATION c�. - Owner's Name ---- --------- -- --- • -�--�---- /r� / P -------------------------------- Address------ - -----6' n - Contractor's Name__(;- ---- - - --------- ._ Phone--------- --_- Installation will serve: Residence Apa tment House p Commercial ❑ Trailer Court E] Motel ❑ Other El Number of living units: _�____ Number of bedrooms._ Number o aths _/--- Lot size ._.__ �sr__.A ----------------------- Water Supply: Public system E] Community system ❑ 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: {lf yes,dote-------_----_____._) 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 ank: Distance from nearest well____d`ra_.___Distance Mrom foundation_..__�`Q_____._.Mat riaL___�- •-------------_--_-- No. of compartments__._.____-----! Size _�__A-/0— ��Liquid depth_____? _--------Capacity. . ___ Dispos Field: Distance from nearest well__..._Distance from foundat•on,____/_`f�____-_Distance to nearest lot line.��_._.v Number of lines-------- Length of each line- Width of trench__.1 Yp •- R p f----------Total len � ---------------- Type -------------- 7 e of filter material �_ __ __,___.__De Depth of filter materiaL___1�_._ length _--��________________________Y Seep e Pit: Distance to nearest well___I_pU___-----Distance from undation___/__`_O_`_.___.Distance to nearest lot line��_-____ Number of pits--- -----------Lining material_{-,_...Size: Diameter__ -"_ Depth.... _______________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----..._____.____________._________. E❑ Size: Diameter--------------------------------------Depth---------------------------------- ----------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well---_---------.-----------------------------------Distance from nearest building-------------------------------____.____. ❑ Distance to nearest lot line - A 1 Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- 4- -------------------------------------------------------••-•--------:------•---------•----------•----------- ------------------••-•---•----•-•----------------------------------------------•-•--•------------------------ ---- ------------------------------------------••------------ -------------------------------•----•-------------------•-------------------------------------------------------•-----------------•---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and r u a ' ns of the San Joaquin Local Health District. ¢ (Signed)------- ------- -- - /or Contractor) By:----- --- -------------- - - ---- f ��} -----�-------------------------------(Title)---------- -------------------- ------ --.......----------- (Plot plan, sh ing size of lot, location o ystem in relatitdsl o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY--- F� •�- ------ ---------------------------------------- DATE---- 7! X7--,141------------------------- REVIEWED 7--, --------------------------- REVIEWEDBY----------------------------------- ------------------------------------------------------------------------------------------ DATE----------------- •-------- ---------------------------- BUILDINGPERMIT ISSUED-------------------------------------------- ------------------ ------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------------------------------------------'----------------------------------------------------- --------- -------•---•----------I---------------- ------------------•-------------.------------------•----------------------------------------------- ----------------------------------------------------------------:-------------------------------------------•------•--- ------------------------------------ ----------------------------------- --------------------------------- ---------------------------------------------------------------------------------------------•-•------------------- --------------------------------------------------------------------- -------------------------------------------------------------------------------- ----------------------------------------------- ------------- -------------------------------------------------------------------------- ---------------------------- --•------- ----------------------------------- -------------------------------------------- -------------------- FINAL INSPECTION BY C - ---------------------- 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 8-S9 3M 3•'63 F.P.CO.