16494 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------- / APPLICATION FOR SANITATION PERMIT Permit No. _.l.tP.l ... - - 3 {Complete in Duplicate) ��I (o ------------------ This permit Expires 1 Year From Date Issued 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. v4lTD �/ � Q � J ,4eQ JOB ADDRESS AND LOCATION- -- -------------------------------------------- ----------------------------- ---.-�---U---- -------------- -------------------------------- Owner's Name-._-- ---•----- -- -�- -- -- -�------�1�� ---------------------------------------------------------------- ------ ----•-•--------------------------Phone.-------- -•- -------•-------•-•- Address ---.._. o� �- ---- Contractor's Name--------- l` �J.K �'c t--zt✓--11------- ' "`'------------------------------------------------ Phone---------------------------------- Installation will serve: Residence Apart}�nentHouse �C1om1 ler Court Motel ❑ t NCr ` Number of living u { *_�-2- urr� er of bedioorns ------ - Num of Leo s e ------------------ -----� _---- -r-�� t_ Water Supply: Public system ❑ Community system ❑ Prue �] Depth to ater Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [% Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote------------ --------) Not New Construction: Yes (X No ❑ FHA/VA: Yes ❑ Now 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_---<2------ is �� f ror foundationc � Ierial_- ---------------- - 19 No. of compartments---�3------------ - ---Size-- -1�-g - --l�--Liquid depth---r�//JJ 6---------------Capacity -Q 42------ Disposal Field: Distance from nearest well >.....--Distance from foundation--:1 "rbj�.Distance to nearest lot line__ -c;---_--_- Number of lines----�---------------------------Length of each Iin�Q=1dU__`" - .Width of trench _�< F�- v_ t/U4if Type of filter material-__V)- -_Depth of filter ma enal_-_---f- �__-_..Total length--_ '1 h------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- I] Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-------------.------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_------------------.-_------------.--. n ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ---._--------------------------- --------------Distance from'nearest building-------------------------------_--------- ❑ Distance to nearest lot line... ---- ------ ----------------------------------------------------------------�---------- ----- R-.341401 doling and/or repa' ing (describe}: r'� ��'! �� - s -- �rC <: ------------- -----• --- ----- - Wiz• - - '-- sr �-� s t" --------- ------------------------------------ --- ------------- ------------------------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------- -------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sf laws, and rules and regulations of the San Joaquin Local Health District. (Signed) L = L• 1-------- ---- --------------------------------------------------------------- -------(Owner and/or Contractor) By:----------------------------------------------------------------------------------------- --------------------------------------(Title)------------------------------------------- --- -------------- (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 APPLICATIONACCEPTED BY------------------------------------------------- ------- ---------------------------------------- DATE--------------------------I--------------- ---------------- REVIEWEDBY--------------------------------------------- ------ DATE-----------------------------------••-•-------------- ---- BUILDING PERMIT ISSUED--------------------------------------------------:--------- DATE-------- Alterations and/or recommendations:--------------------------------- - --- - -- . ----------------------------------------------- . ---------------------------•------------------------------------------ -------------- --------------- -------------------•------------------------••-----------------------------------------------------------•-------------- ---------- ----------------------------------------------------------------------------------------------- ----------------------------•-------------------------------------------------------------------------------------- ---•-•-------------------------------------------------------- ------ ------- ------------------------------------------------------------------------------------------------ ----- ------------------------------- --- --------------------------------------------------- ---------------••----------- - ------------------------------------------------------ -- - FINAL INSPECTION BY------------ ------- .-- --- --- Date------- ------/ l�~S� 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 8-59 3M 3-'63 F.P.CD.