18735 - Laserfiche WebLink

Home Browse Search

OFFICE USE: . Permit No. _}_ --_.•- ` -7 - .._.__-_ "" _ _ — APPLICATION FOR SANITATION PERMIT / ---. �/ - ----------------- :-- (Complete in Duplicate),. - " - --Date'Issued Y --• � _ - ---- --------_--.-_- �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. I. ' S'.--:'�yh r�r� C ...... l- --------------------------------- ---- JOB ADDRESS AN��CATION__::______y-. ----- ` _. Phone----•-------------------- ------ Owner's Name.----- �tni"` l------- ' - _ _ - AddreAdd ss---------- c _ .:!7?!liz ^_c4 Contractor's Name---------"-- r�---"- -- -----"---••-----------------------"--- r Installation will serve: Residence r Apartment House E] Commercial [I Trailer Court [I Motel ❑ Other C1 Number of living units: -4--- Number of bedrooms - -.- Number of baths -_______ Lot size __"13/__ -�-X _ Eg Water .Supply: Public.system F1 Community system El Private lav ,(e pth to-Water Table -------- ft. Adobe ardpan C1Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam ❑ Clay Loam ❑ Clay ❑ <' _ _ -) No New Construction: Yes Q---No 0---FHA/VA: Yes ❑ No [I -` '1-Previous Application Made: (lf yes,date.__.__ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p: i Septic Ta k: Distance from nearest well__-- Q_.__Distance from foundation_.__ --_-----Materlai.__ _l?___ Y"_ -., ------------•- ld'-- • 7. No. of compartments - =Size._..! 'X__`I 3 Liquid depth. Capacity Q Disposal Field: Distance from`nearest well__,, ?---.--Distance from fdundation____LC _______.Distance to nearest lot line-----55.___...___ Number of lines____.._____ __ ."__-._.__'�-.Length of each line__J7x- ,zc S�_.Width of trench.......�_4'�------------------ ,,. T• e of�fiiter material__ - --��----Depth of filter material_-__-_!�_`�___---Total length____.___�._�_'r_-__.'---------'-----�---- Yp , �i Pit: Distance to nearest well__,!.©O_____-_----Distance from-foundation_____� l------.Distance to nearest lot lin^- -----.----- 1 -----_---Lining material_ - .Size: Diameter---- ��-- ----Depth------�- ----------------- Seepage. - s7--- - 3 Cess ool: Distance from P nearest well______________._:Distance from foundation-------------------.Lining material----------.---"---------------- p als. ❑ - -------Liquid Capacity---------------------- g O Size: Diameter-=------------ ----------- --------- Repth------------------- jt. t..:.:._... -----------------Distance from nearest building ' I Privy: Distance from nearest well-------------------':-- ❑ --------------------------------"----•----------------------------- Distance to nearest lot:.line_..'------------------------- - i:-- Remodeling and/or repairing (describe)----------------------------------f= f ------------ ---------- ------------------ -----------,---- - - ..._ ___._.- T. ---_- - --------------------------------- ________ -----------------------; 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 regulations of the S Joaquin Local Health District. _-__..._(Owner and/or Contractor) (Signed) �Iz'�' --- ----- l } r %" ------------------------ -------- - BY: --------------•----------------------= -------------------------------------------- -------------------------- -- --- --- - (Title)e (Plot plan, showing'sixe'of lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side]. l FOR DEPARTMENT USE ONLY s - - ;, ---------------------DATE--------- - -�� `��---1----------- APPLICATION ACCEPTED BY----- -- -- - ------ ---------- " ------- DATE---------•-------------------------------------------------- REVIEWEDBY------------' --------------------- -------- --------- -----=--------------------------------------- BUILDING PERMIT ISSUED------------------ ----- DATE -- ._�. ------------ Alterations and/or reco menda+ions:-- -- -------------- ------------- ------- ----------------- -- ----- Date----------------------- - --------- ------------------------------------ FINAL INSPECTION BY:.------- -- -------------------------- SAN JOAQUIIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. ! 300 West Oak Street 124 Sycamore Street . 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED e-59 3M 3-'63 F.P.CI7• `-�,:=4