17278 - Laserfiche WebLink

Home Browse Search

50RFFICE USE: -. ,--- Permit No. /7 �u APPLICATION FOR SANITATION PERMIT in Duplicate) Date Issued ----------------------• -. ------� - --- tea (Complete { ° _ This Permit Expires 1 Year From Date Issued a -------- - ------- - ------ Application is herebymade 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----T:_.-------- Owner's Name---------- / .G I ------------ -------------- Pone --•--------•-- Address_.------- -----------'-- .. ------- - ---- --- ------ -------------------••--------•---------•--- Phone--------...----•------------------• Contractor's Name__.__:_-."- --�� -i � Installation will serve: -Residence I partment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other ❑ Number of living units: _____j_ Number of bedrooms _ - Number of baths -7—. Lot size _ -- ------------ Water Supply: Public system ❑ Community system ❑ Private ❑�f�pth to Water Table 'Clay ft' Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am ❑ Clay Loam ❑ Clay ❑ No ❑-- kt es date___----------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ Previous Application Made: ( yes, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well-----------------Distance from foundation------------:--------Material------------------------------------------------- N ----------------------------- -----No. of compartments---- ------ ------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- _____.Distance to nearest lot line_________________ D sposal Field Distance from nearest well__----____----_.Distance from foundafiion__-_:_____-_-" ll Number of lines----------------------------------=:Length of each line---------------------:--- ----Width of french_--'---•--------•----- : ( �l>� Type of filter material---------------- --- =---Depth of fitter material_---- `---------Total length------------------------------ • ___.Distance to nearest lot lme_`�---•----- Seepag it: Distance to nearest wel!__�Q"d---------Distance frrom foundation__ ____________ �j ___AC - �S- 00 l3Dp}n_ Size: Diame _ Number of pits--------------------- Lining materia_ l Cesspool: Distance from nearest well------------------Distance from foundation---------- --------Lining material----------------------------------- als. De th_._. Liquid Capacity----,-----------------------g F1 Size: Diameter--------------------------------- p Privy: Distance from nearest well--------------- Distance from nearest building-------------------------- to nearest lot line --- ------- ---=-- T � ®' i _ 4 s Remodeling and/or repairing-[describe):______ �4 - ----------------- ------------- ------------- t -----------------------t ----•----------- •-----•-----------------------------------------------•--------------------------------------------I------------- ------------- --------------- ------- ------ -------------------------------`---------------------- ---------------_--•-------•----=--------------------r-------"---------•---------•------------•-------------------------------- - 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 rule r gulations of the San Joaquin Local Heath District. G -(Owner and/or Contractor) _ - (Signed) - : I _ - - -- --- -- ----- - a. = ) [Plot plan, showing size a , location of,system.in relaf n to wells, buildings. a+c., can be placed on reverse side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ t '� --------------- DATE-----�:. - _r -------------------------------- 14 DATE----------- GREVIEWED BY ---- ---------------------------------------- ------- ------------ _ BUILDING PERMIT ISSUED--.------�;-------------------------------------------------------------- DATE_ -------- --------------- Alterations and/or retain ndati �' -------------------------- !� :.- 7— -------- --------- - ------- ----------- ----- ------ 1 �....-- ------------------------------ • 7 ...yam � _Y..�:r�.w '"�' i - ��/• ____ _______________________ FINAL INSPECTION BY:.__----. - - -------------- Date - --- ---------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Lodi,California Manteca,California Tracy,California Stockton,California , ES 9 REVISED 6.59 3M 3`63 F.P.EO.