16690 - Laserfiche WebLink

Home Browse Search

I =FO,<OFFICE USE: -r-�' X �. ------------ ----------- ----------- ___._--.______--.- APPLICATION FOR SANITATION PERMIT Permit No. ------------ ------ ------------ --------------- ----- (Complefe in Duplicate) l!te II Date Issued --_-._-- lt_ �o --- -- ---- --------------------------------------------- This Permit Expires 1 Year From Date Issued 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. Ei JOB ADDRESS AND LOCATION--o3Q.- ` ` 'L ---------------------------------------------------------••---------------------------------•------------ Owner's Name N -------------------•-----------•------------------------ ------------------------------ ------------- Phone---- --•-------------------•--- X Address ,�a�r��,�-LYS ------------------------------------ = .. Contractor's Name--------- -, -- �----- ---------••------------------------------------ ----------------••----•--- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1� �) Number of living units: I------ Number of bedrooms __;2 ,Number of baths -__/__ Lot size ` _ b$ •-------------------------------------•- Water Supply: Public;system .2-11,c—ommunity system ❑ Private ❑' Depth to Water Table &i_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L�_Hardpan ❑ Previous Application Made: IIf yes,date ......)�',No, f New Construction: Yes No ❑ FHA/VA: Yes ❑ No P� TYPE OF INSTALLATION AND SPECIFICATIONS: tet, it (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - r Se tic nk: Distance from nearest well--- ---__Distance from foundation_ _(t-------------Material__ _.___.__.____._.._.. ----------------- No. _ __._.___ __. !I No. of compartments--- -- ------Size----3_�4..�._�C-- -----.Lir d de th_-.- Capacity--p-P-9-- -A, _-- a P. �-------- Disposal field: Distance from nearest well--- -----Distance from foundation--i�-_-___--_--.Distance to nearest lot line_��':- " Number of lines____________ __________________Length of each line__._$_._` Width of trench-.4f.-1 r-------------------- !� Type of filter material' TOC—!f---.---Depth of filter material-.f l"f--�_____-Total length-----0../__________________________ Seepag It: Distance to nearest well_-_�. --__-__Distance from .foundation_A ..---_---.Distance to nearest lot line-- ----------- W a I !I Number of pits------,.1_....__ -Lining material_ _G_G_,f.-- Size: Diameter_-33._.._....__Depth.... ---------------- Cesspools Distance from nearest well--------------- from foundation-------------------Lining material--..-____.--__.--_-_:-_--_____---_---. � ❑ Size: Diameter-------------------------- ---- ------Depth-------------------------- -- ----------------------Liquid Capacity-.--------------------- gals. Privy: Distance from nearest well-_.._--r"_r________________ ---------------Distance from nearest building_-._.___.________________.____________._. li❑ Distance to nearest lot line_______ _____°.___________. �0 Remodeling and/or repairing (describe)--------- --------a, .---------------------------------•-----------------••-•----------------- --------------------------- -------------•----•------------------------------------------------•-------------------------------------------------------------------•------------------------------------------------•---------=-------------- ------ k r ----------------------------------------------------------------•---•-------------------- -----------------•---------------------------------------------------------------------- a I hereby certify that I have prepared this applicatiorLand th9t the work will be done in accordance'with San Joaquin County ordinances, State laws, and rules and regul ions the San Joaquin Local Health District. r 1' f (Si,i in - - 9 )--------------------------------------------------- ---- - -- -----------------------------------------------------------------------------(Owner and/or Contractor) I By:--------------------------------------- ------ -- ------------------------------ -----------------------(Title)-------------------- ---------- ------- - -- ----------- (Plot plan, showing size of lot, ation of system in r ation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_------ 4 c -----------------------------------•-----------------I----- DATE------- ZZ:-6- ---------------------- REVIEWEDBY-----------------------------------------------------------------------e------- -------- ----------------------------------- DATE----------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------• DATE-------- ----------------------------------- Alterations and/or 4ecomme dations:_. _ ---- --------------- --- -- Ir"` - - e --------- • ---•---------------------------------------------------- -- -----------------------------• ----- :t ------ ____ ------------------------------ _...__._______._.__. ____ _ _ ------- F1 NAL INSPECTION BY:.- p --------- -------- ----------- Date---- < -d •, ;. y 4 SAN JOAQUIN LOCAL HEALTH DISTRICT F j ii EI 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I rt, i� Stockton,California Lodi,California Manteca,California TFacy,California ES 9 REVISED B-$g 3M 3-•63 F.P.CC.