17234 - Laserfiche WebLink

Home Browse Search

'FOR OFFICE USE: -------------- ----- --------------------------- --- No. APPLICATION FOR SANITATION PERMIT Permii ..... -------------------------- --- -------------------- (Complete in Duplicate) Date Issued ----- -------------- This Permit Expires 1 Year From Date Issued 23S— (00--(9 Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described This application is made in-compliance with County Ordinance No. S49. of IAA -50 -- - ------ ------------ JOB ADDRESS AND"LOCATIONAj--=-----------------------------------•----------------------------------------- ---------- Owner's ff9 .Sl)------- 7t-- �,J< t ' Phane-------------------------- -------------------------------------- _8 ----------- Address --------- ------------------------------------------------------- I Contractor's Name_.__- ----------- ------------------------- -------------I------ ------------------------- ---------------- Phone.Ad P!__5�47A.74-___ Other E] Residence JN Apartment House E) Commercial Trailer Court [I Motel [I Installation will serve: . 0 Number of living units: -J--- Number of bedrooms Number of baths ---I_ Lot size------ ..*-------------------------- Water Supply: Public system El Community system ED Private k Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand FM El Clay El Adobe U Hardpan 0 Gravel 0 Sandy LoaM. 0 Clay Loam 4 9-- Previous Application Made: (if Y_es,cicite:---- ---- --------) No R2 New C;nstruction: Yes e No E] FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: - No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ---6stance from foundation_---"/!-----------Material_ V) No. of compartments------2---- ---------f Size----J_*47'X-1........Liquid depth-----I- --------------Capacity- dao Disposal Field: Distance from nearest well from foundafion__J�......._Distance to nearest lot line-.1........... .........Distance Et Number of lines--------J------------------------ILengfh of each line..... ----------------Width of trench.-_-Z".-..r--------- ---------- Type.of,filter-material--- --------------------- - -k------'Depth of filter-material material:---/IfIf ------ --Total length----__-1Ak Seepage,�If: Distance:tance to nearest well-.--------------------Distance from foundation--------------"----Distance to nearest lot line-------I I----------- I ❑ -_Qtuber of.pits.---------------------Lining material---------- ------------Size: Diameter-----------------------Depth---------------------------------- mber OT.p�fs. ..............." I Cesspool: Distance from weil-----------------Distance from foundation----- --- -----Lining material---.--__---____--------"---------_ ❑ aterial-------------------------------------- 0 Size: Diameter-------- --------- ------------- epfh-------- ------- ----------i--------------- ------------------Liquid Capacity----------------------- 1---gals. Privy: biistance from nea--rest well --------- - --Distance from nearest -- --- - - ------I-- -------------- F1Distance to nearest lot line---------------------------------------------I--------------------I- -------------------------------------------------------------- 1 1: -------- --------------------••--- ------------- ---------- Remodeling and/or repairing (describe]---------------------------------------------------------I------- ------------ ---------: --------------------------------------------------------------------------------------------------------------------------?r------------------------------------------------------------------------------__------- ----------------------_------------- "--------------•----__---_-----_-___-_•___---_"-----_-----•___----------k------------------------------ ------------------------------- k I A -- ------------------------------ -----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 rules and regulations of the San Joaquin Local Health District. -----------------(Owner and/or Contractor) - -- - ---- ----- -------------:--------------------------------- (Signed)-------- 7_ --------- - ----- ------ .--- f F I By:---------- - -------- ---- - -- --------------------------------I------------------------{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 =� APPLICATION ACCEPTED BY------- --- -- ------- --- DATE-------- ---------- -------- ----------- REVIEWEDBY-------------------------------------------- - ------ ----------------- ---------- ------ --------------- DATE----------------------------------------------- ---------- TE--------------------------------------------------- BUILDING PERMIT ISSUED----------- ------------------------------------ ------------------- DA Alterations and/or recommendations:-------------------------------------------- ---------------------------------------------------------------------------- ---•-------------------•-------- I ------------------------i-------- -----------------------------------------I-----------------------------------------I--------------------------------_-------------- ----------------- ----------------------------------------------------- I -- ---------------------------------------------------------------I——-------------------------- ----------------------------------------------------------------------------I--------------------------------------------- ----------------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------------- ------------------------------ ---------- - ----- ---------------------------------------------------------------------------------------------------------------- --------- ------------------------------ ------I-- ---------------------------- .... ------ ......... FINAL INSPECTION BYI:._"C.----- ----i -- 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 B-59 3M 3-'63 r-rp-1213.