18727 - Laserfiche WebLink

Home Browse Search

_4! FOR OFFICE USE- ----------- - ------------- --------------------------- SE:-------------------------------------------------------- - ----------------------------'---- ----__-..-------.-_ APPLICATION FOR SANITATION PERMIT Permit No. .-- - __rtyj!__ -� -- ----------------------------------------------------- (Complete in Duplicate) J7 / -------------------- --- -------------- ----- This Permit Expires 1 Year From Date Issued Date Issued ---_- --- -- S 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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT O ----- Owner's Name----- ��--• 44- --- -------- - Phone --- .� Address.-•--•----------- �! � '�.-�?!� ��._.. -----------------------------•------------------- ------------- Contractor's Name .. - te——--..----------- ------ Phone----••--••----•-------- ... Installation will serve; Residence ❑ Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �� Number of living units: z---- Number of bedrooms - -- Number of baths - -- Lot size -_�-L _ - -`Id, W Water Supply: Public system ❑ Community system 4] Private ❑ Depth to Water Table._---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam 2j Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------_------------) No& New Construction: Yes Pfl No ❑ FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Z. Distance from nearest well__fd-------Distance from foundation__Z/q-r-----._-.Material_ "' ( No. of comportrrients----' -- ---------------Size__ - ---±K_----------Liquid depfih-_- -- ----- - --------Capacity-p-----rr`*��----------- T Disposal Field: Distance from nearest well__5L-?--------Distance from foundation_6p- ------.Distance to nearest lot line_S---------- ] Number of lines-----_-V--- ----------- --- Length of each line------rF�------------------Width of trench--- ---------- 4b b Type of filter mafierialf _Depth of.filter material---/?-------------Total length---- Seepage ength_-Seepage Pit: Distance to nearest wet--_--_-------------Disfanee from foundation-------------------.Distance to nearest lot line-------------- _-- ❑ Number of pits----------------------Lining material---------- ----------..Size: Diameter-----------------------.Dept h-------------------------------- 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-------"-----_----_--- _- ❑ Distance to nearest lot line------------------------------------------------- Remodeling and/or repairing--- (describe):-------------------------------- i - --------------I— ------------------------------ ------------------------------------------------------------ -------•-------------------------•------------------------------------------------------------------------------------------------------------------------- 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. I (Signed)._----- - ----------.(Owner and/or Contractor) By- -----------------•--- -_---------------------------------4------ ---------------------------------------------------------(Title)---- ------- -•----------------------- - --- -- -------- (Plot plan, showing size of lot, location of system in relation.to wells, buildings, etc., can be placed on reverse side). a Ar I FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--/• '�r��a.4,.f - DATE 3 -` — . ---------------- --- REVIEWED BY ---------------------- ---------------------------- -- ------ DATE. -- -------------------------- UILDING PERMIT ISSUED-------------------------- - �-------------- ---- •---- DATE---------------------- ------ -Alterations and/or recommendations:"f-------------------- - - ------------------------- c. ---------------------------------------------------------------- -------------------------- ---------- -- - -- ----------------------------------------- ------------------------------ - - -- ----------------------------------------- w FINAL INSPECTION BY:....e!40' .te te -----•--- ------------ Date---3-2—q: _"6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California FB 9 REVISED 8-59 :3M 3-'63 F.P.CD. i