16674 - Laserfiche WebLink

Home Browse Search

4FO OFFICE USE: S --// __--_ APPLICATION FOR SANITATION PERMIT Permit No. ._ _Iz..(fJ..y . ----------- -------------- ------------------------------ (Complete in Duplii:ate) Date Issued ____ ----------------_----_--------------------------- This Permit Expires 1 Year From Date Issued z-,;: Application Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is,made in compliance with County Ordinance No. 549. f Yq,et L, , GiJ•e-a Al:cm! JOB ADDRESS AN LOO A •--- �77 - - Owner's Name------ '---------• -0/1 .. ---------------------------------------------------- Phone- -srl� Address *_' ". _ _c (�-- ��' ._ � ---------------------- --- - Contractor's Name_�>�t�-.. � ------------ Phone._f7--IQJ- `_/_. Installation will serve: Residence artment ouse Commercial Tr I er Court ❑ Motel Other ❑ Ile Number of living units: ___I__._ Number of bedrooms _ + Number of baths _1____ Lot size ___ ___� _ ___________ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------ - _1 No ❑ New Construction: Yes ❑ Naaff--FHA/VA: Yes ❑ No ❑ J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubtlic-sewer is available within 200 feet.) Septic Tank: Distance from nearest welL�_ .__Distance fro �found�.tion__.��--__.-_Material_______..__-__ ________.' _-_. 5K No. of com artmen#s____ .______ rr t �r�lb, Size. ____�_____.�_ ------Li aid de th__„�`r--_- - _.__ Capacity--le®'_ I / / sposal Field: Distance from nearest well .__..._.Distance from foundation.-/-__�__________Distance to nearest lot line___ __ __ Number of lines____``__------ g --! Length of each line____�[-'___C?__ ___________Width of trench-�____._________ _`.-- Type of fitter materia l4iL-_�`%_Depth of filter material--_____,L' __"�_ Total length___________________ �r__�__.____ Seepage Pit: Distance to nearest well----------------------Distance from foundation________.___.._.___.Distance to nearest lot line----------------- El 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-------------------------------------------------Distance from nearest building---------------______________________._. w ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--- -r------ - �--------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------•---------------------------------------:----------------------------------------------------------------------------------------------------------- I hereby cer ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, (a ar krules and regal tions of the San Joaquin Lotal Health Dis Dict. l i oContractor)-- ------d) - - e -CSigne{ . By:---------------- ----------------------_.-._....---------------- -------------- --- ------ (Title)------------------------------- ------- - ------- -- (Plot plan, showing size of lot, location of system in relation to w �b�aildings, % ., can-be placed on reverse side). FOR DEPARTMENT USE ONLY / / APPLICATION ACCEPTED BY----------------------------------------------• - U-�------------------------------- DATE-------- l J ----------------------- REVIEWEDBY----------------------------------------- - - ---------------------------`-- ----------------------- DATE----------------------///---------------------------- BUILDINGPERMIT ISSUED----------------------------------------------=----------------------------------------------------- DATE---------------------------------------------------- Alterationsand/or recommendations-------- -------------------------- -------------------------------------------------------------------•------------------------------------------------------- --•------------------•-•----------------------•------...--------------------------------------------------------------------------------------------------•---•-----------------------•---------------------------•--- --------------------------------- ------------ •------------------------------------------------- ------------------------------------------------ ----------------------------------------------------------- ---------------------•-------------------- ----- ------- -•------------------------- -------------------------------------------------------------------------------------------------------------------------------- ------ FINAL INSPECTION BY------------------. ------------------------- Date-- ---------- �----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CO. F