17467 - Laserfiche WebLink

Home Browse Search

FO OFFICE USE: r -- �,„---y----_�•:..----- ..; Permit No. -1--- ••- ... ._�-- ---- -- - --/,3 4 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) y t ______________________________ This Permit Expires Z 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. i JOS ADDRESS AND . OCATiO..._.____ '__a� Q-- - - �� J- 12-------------------------------------------------------------- -- Owner's Name - : - Phone - L Address -a...._.. -`� ---------------- �T - = = •:--- Phone{ Contractor s Name_.-------- •----•- ' ---------------- _ I Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel�a\ Other ❑ Number of living units: _�'__ mbar of bedrooms __--___ Number of baths Z____ Lot size _____��-.` -1_40-0-•----------------------- 1 �_ �+ t � � I Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _6--7ft. Character of s it to a depth of 3 feet: `Sand ❑' Gravel ❑ San oam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ t ' Previous Application_Made:_.(.Lf_yes,date, 1 No New Construction: Yes ❑ No p-'_FHA/VA: Yes El No E3—'` TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic T Distance from nearest well------.-:Distance from foundation_--/_C--------Mate rial IC-�_--- --------. - --------No. of compartments----- _ Size . 0_ Liquid depth____ -----__Capacity- Disposa eld: Distance from nearest well ____.Distance from.foundation-_ --r____-Distance to nearest lot line____r�-__-__f___ Number of lines------------ Le gth of each line--____�/0_/ ------ Width of trench--CD- --j__-------------- Type of filter material- _112. X�4+C�epth of filter material____J_�__�� __.Total length___.______�f _________________/____ See pa it: Distance to nearest well...__!!!"- Distance from foundation___ __1__.__-Distance to nearest lot lig-e____�______ number of pits------ Lining materiaL_ K�___..Size. Diameter_ _��...__..Depth___c �-�- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------________________. ❑ Size: Diameter--------------------- -------------- ------------------Liquid Capacity--------------------•------gals. --------------- Depth------------- ----- I Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building'-_______-----___________---__-.-------- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------- --------------=-•------------------------------------ Remodeling and/or re aring ----- --� ----------- � ��••-- r t -------------- ---------------------- --------------------------------------- ---------a- ------------------ - --- . ..... --------------------------------------------------- I ---------------•-------------------------------------------------------------------------------------------------------------------- 1 hereb ify that l hgan ed this application and that the work will be done in accordance with San Joaquin County. ordinances, S to s, and rgulations of the San Joaquin Local Health District. (Signed)---------- - "Z-�---� - ------- --- -------------- ------------------------------------------------------ (Owner and/or Contractor) BY= - --- �� (Ti+le) �.�' �1.. :.�(Plot plan, showing size of lof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y '« DATE---- --- -----•------------------ --------------------------------- REVIEWEDBY------------------------------------------ ------------------------------ ------------------------------------------------ -- DATE----------------------------------------•------------------- BUILDING PERMIT ISSUED.-_----------------- --------------------------------------------------------------------------------- DATE---------------------------------------- ------------------- - Alterations and/or r com en ations: - -----•--------------------•-------•-- ---------------- � ' s ' ---- -` • --- ---------------------- ,r ` ----------�-'-`-------`�. �r`�`fpm 't'r�' �� ''/r--- -------------- "�' --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------•------------------- --------------------------------- -------------------------- -------- i Date.------ �� ' - -------- ----------------------------- FINAL INSPECTION BY:-------�=----�=�-------------- -- ------- ---------- -� JF . SAN JOAQUIN LOCAL HEALTF•t DISTRICT 1601 E.Hazelton AS e:N, i �• 300 West Oak Street 3 124 Sycamore Street 205 West 9th Street Lodi,California -Mantecd,California Tracy,California Stockton,California r.5 9 REVISED S-S9 3M 3-'63 F.P.CD. - r