17609 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --- ------------------------------------ ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------------- -- (Complete in Duplicate) Date Issued ._-.. 3Q6 j/ --------------------------------------------------------- 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. _�,.)b _ �.3 Fy - JOB ADDRESS AND LOCATION---------- ----j-.�-f-T ------- C------------------------------------------ _l� -----• ---------- -- ---- Owner's Name._ z Lc"---'' 5 .:. ---------------------------- -------------- -------------------------- Phone..62R__T60,_.'j----- Address........ .. 44 _� ,ft-=' -------------------•------------------------• -------------..---•----- Contractor's Name-------- -- ------ Installation ---Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____t___ Number of bedrooms _3__ Number of baths _y_ Lot size _____ ......x__.2.647------------------- Water Supply: Public, system ❑ Community system ❑ Private IV Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I< Hardpan ❑ Previous Application Made: (If yes,date---------------- _._) No New Construction. Yes �' No ❑ FHA/VA: Yes ❑ No W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.Tank: Distance from nearest well---- _! ___Distance from foupn�dation-__A-0-.-------Mat grial--- �..Cc--------__________ No, of compartments., -- - __________Size______ ./ 2 E p `_X S`-�--- 3__:__Liquid depth--------- Capacity-1-- 'Q----04-- i r ` r 1 Disposal Field: Distance from nearest well-_-_ ___-_Distance from foundation-____ �______.Distance to nearest lot line___11_____-_.__- Length of each line__________ ifrench !� Number of lines--------'-�----- --------------Width of ------- Type of filter material!�z C�__Depth of filter material____-_ _ ..._______Total length_________-____ r` (?__�_______ �•! Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- to nearest lot line-_------_________ *J ❑ Number of pits--------------------Lining material-----------------------Size: Diameter----------------- Depth---------------_----------------- [� Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material-------------------------- [❑ Size: Diameter-------------------------- ----- ----Depth------------------------------------------- ----Liquid Capacity_.-------------------- gals. Privy: Distance from nearest well------------=-------------------------- g-_.------------------------- ----------. _. ._________Distance from nearest building-_. n ❑ Distance to nearest lot line--------------------------______-_ p� Remodeling and/or repairing (describe):-----' ��'� _ �'" '•-� --------------------•---------------------------------• 4 t ---------------------------------------------------------------- ------------•----------- -------------------•--------------------------_------------------------------------•--------------------------------------------- - --•--------------------------------------------------------------------- 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 rregulations of the San Joaquin Local Health District. (Signed)-------------f-I'L/ vr` ---° i.. ------------------------I wner and/or Contractor) ._..._-•---->�-c.�,- -- __ .__�_ ._r_�..�---------------------------------------------- --------true)---------�--- --- ----�------------....----�--�----- ------ By: -� (Plot plan, showing size of lot, location of.system in relation,to wells, buildings, etc., can be' placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.---'4' '-------------------------------------------------=------ ------ DATE----(0/ REVIEWED BY------------------------------------------------------------------------ DATE ._ ------ _=:.=r -- ------------- BUILDINGPERMIT ISSUED-------------- -----------------------------------------------—-------------------------------------- DATE--------------------------------------------- Alterations and/or recommenda+ions------------------- --- ---------- ---------------------------------------------------------------------------------------------•----------------------------- -•-----------------------------•----------------------------------------------------------------------------------------------------- ------------------------------------•------•-----------••--•------------------- -----------------•------------------•------------------ ---------- - ---------------------------------------------------------------------------------------------------------------------------------------------• --•---------------------------------- -------------•----- ------------•---------------------------------------------------•--------------------- -------------------------------- ------------------------------ FINAL INSPECTION BY:--- - ------------------------------ Date- 7 ---------------------------------------- k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California rG 9 REVISED B-59 31A 3-'63 r.R00.