18604 - Laserfiche WebLink

Home Browse Search

FOR OFFICE' SE: �I ii APPLICATION FOR SANITATION PERMIT, ' Permit No. ----- -------------------------- (Complete in Duplicate) a Date Issued ------ ----- ---------------- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to const_ ctan install the work herein described. This application is made in compliance with County OrdinancqNo. 549. g i JOB ADDRESS D LOCATION-• �! `7`r - ----• -------------------------------------- Owner's Name ---•--•------------ - ' Phone----------------------- Address `fir --•---------------------- ------------------_--_-------------------------- Contractor's Name-------------------------------------------------------!%----------------_-- -------------------------------------------------------------- Phone..._-_----------•---- Installation will serve: Residence E] . Apartment House E] Commercial [:] Trailer Court ❑ Motel El Other �.. Number of living units: �'_ Number of bedrooms ----Number of baths I--- Lot size ___'� ,._ - �.��----------------- Water Supply: Public system �ommunity system ❑ Private ❑ Dept -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:1; (if yes,date____________________) No F1New Construction: Yes ❑ No ❑ FHA/VA: Yes ElNo El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer--is available within 204 feet.) ---!• - Septic nk: Distance from nearest well________ ____Qista ce from foundation__-__� .`_-___-Materia!_ ___________________-_--________-.____.- .: ` No. of compartments____-- Size _ ___ ..Liquid depth_____ j_______-Capacity___ �_p Dispos Field: Distance from nearest well-.-..� ---_Distance from foundation.._, Q�.__Di tante to nearest I tine '____-_____ .Width of trench ------------------- Numberaof lines---------- --_�y---------Length of each line______�Q__'._- �--_-- Type of,filter material___. l f-.-,,--Depth of filter material____. length___5_a__ -----_------------------- Seepage Pit: Distance to nearest well______________________Distance from foundation--------------------Distance to nearest lot line----------------- i ❑ Number:of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- W rom nearest well_________________Distance from foundation___-________.______.Lining material__-___-_._- __ ___-____-_-. ____ Cesspool: Distance f El Size: Diameter-------------------------------------De th-----------------------------------__--- --------Liquid Capacity gals. Privy: Distance from nearest well ________________--------_--------------------....Distance from nearest building----------------------------------------._. Distanceto nearest lot line--------------------------------------------------------------------------11--------------------------------- ------------------------- -- T ,i f Remodelingand/or repair; 'g (describe):------------------ --------------`----------------------------------------------------------------------------- ------------------- ------------------------- II ----------------------------------- --------'-------------------------------------'-----------------------------------------------------------------------------------+--_---........---------- •------------------- -------------------------------- :ilk I --------- - ------ - ' I hereby certify t t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la ,/ ndlrules and regulat' sof the 5an'Joaquin Local Health District. I (Signed)-_ Q `----' ----- ----- - --- t-{BvtRf2� and/or Contractor) ----•-------- ---- ------ ------ I - - _ - ti el - rBy:. ----- .. 1...:. (Plot plan, showin sire of lot, location of syStem.in relay to wells, buildings,etc., can be placed on reverse side]. II FOR DEPARTMENT USE ONLY �s APPLICATION ACCEPTED 13Y --------------------------•---------------------- DATE--�� 6 ------------------------------ REVIEWEDBY--------------------------------------- - DATE--------- ---•-------------- - BUILDINGPERMIT ISSUED-----------------------------------------------------------—------------------------- ---- DATE=-------------------------------------------------- ------ Alterations and%or recommendations -------------------------------- T I; `_ I - r . - ' ---•-------------------•--•-------------------=---------------- ------_----- ------- -- -----------' -----------=--------- --------- - ---- •-- Il ---------------------------------------------''------------ ----------------------- ----------------------------- II ----- FINAL INSPECTION BY'- ----------------------- Date ' ' I, SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Ho:elton Ave.!!. 300 West Oak Street 124 Sycamore Street 205 West 9th Street a Stocklon,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9.59 3M 3•'63'F-P.CO. II