17482 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: _ ------- --------------------------- ------------------- - Y ----------- ------------ ------------- ---------------_--. APPLICATION FOR �" SANITATION PERMIT Permit No. ZY-� " ------------------------------------------ ------------ (Complete in Duplicate) l This Permit Expires ] Year From Date Issued J4. Date lssuecl 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." -_-_ _ -�' Owner's Name_-__`__� _____ �r�'/� - = -------- Phone=----------- Address-------- z.-t-.-.?�iy__-° off'--` ` Contractor's Nama .-._---- ---•-- Phone----_--_------------- Installation will serve: Residence.® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------ of bedrooms---- Number of baths -------- Lot size__ -------------- Water Supply: Public;system El Community system ❑ Private•k Depth to Water Table 30__ ft. Character of soil to a depth of 3 feet: Sand (] Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ � I Previous Application Made: (If yes,date.---- ..-----I No X1 New Construction: Yes El No � FHA/VA: Yes -1 No ❑ 1 -TYPE OF INSTALLATION AND-SPI;CIFICATIONSr7 (No sepiic-tank or cesspool permitted if public sewer is available within 200 feet.) � �C3 Septic Tank: Distance from nearest well-----------------Distance from foundation---------.----------Material ❑ No. of compartments-------------- ---------:Size----------------- --------- ---Liquid depth---------- ------------- Capacity---------------------- T— Disposal Field: Distance from n ares! well"- ------------Distance from foundation___7?�---------Distance to nearest lot liner"t o "O .I Number of lines-' - Length of each line--- D'- ---------------Width of trench__�_�_-----•--------,----..__ _Type.of filter m 4 ateria, '' ___Depfh,of filter material....1_Q_`i""""_-._Total length---I------------------------------------- e 'V"____,___ `! � + --------------------- eepage'Pit: Distance to nearest well----------------------Distance from foundation_. _:_ --------Dist...e to nearest lot fine-- ---_- ❑ Number of.pits_.---------------------Lining material- Size: Diameter--------------- -------Depth------------------------------ Cesspool; Distance from nearest well-----------------Distance from foundation---_---------------.Lining material..........__._"""""-"___""""-_-___-__. ❑ Size:'-Diameter.----`---------------------------------Depth---•------- ----- Li Liquid Ca Capacity gals. rqP Y --------- Privy:. Distance from nearest well-------------------------------------------------Distance from nearest building 9 _ ❑ Distance to nearest lot line------------ �-------------- --------------------------------- ------------- ------------ ------------------------ ----------- 11 3 Remodeling a j,,6 _r " airing (describe):--_---- �'� I -------------------- - __ I ---ja -'u ---•------•----------•-------• - ------------ --•----- - ------ hhereby c �tify the I have prepared this application and that the ork will be done in accordance wish San Joaquin County dk 4� ordinante , Sta a la bv band rules and regulations of the San Joaquin L cal Health District. Isigned)- - ------- -----------`' - _. _-} r....�.� . , .�. ,,� - -- --- Owner and/or Contractor) By ` -- --- �---------------- ------------ --- ---- - ----- Title ------------------------------------ ._ -. . - (Plot plan, showin4size of lot,Jocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - --- -- ---------_--------------- DATE-" _��_--6 - ---- ------ ------- -- ----------- - - REVIEWED BY------- -- --------------- -------------- ------- - DATE- ---- ------- --------------------------------------------------------- BUILDING PERMIT ISSUED_ = ----- ------------------------ --------------------- DATE------------ - -------------------------- Alterations and/or recommendations:"___.- ----------------------------- a A � n -.__ --- -------------• -- - .--------------------------- --------------------------------- ------------------------- - - t : FINAL INSPECTION BY - . 1--- Date"".G. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Californiat Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P.Cq,