22622 - Laserfiche WebLink

Home Browse Search

FOR OFFICE US1 t--,��------ -- APPLICATION FOR SANITATION PERMIT Permit No_ ________ ----...- r ----.. _ _.- r - (Complete-in Duplicate) , Date issued ------- ------- ----- - This Permit Expires 1 Year From Date Issue s Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pp compliance with County Ordinance No. 549. This application is made m com Iia "-•-"--"-"---------------------------------- ----"-."."--"------" ""--"-".-♦ """--- A /�j JOB ADDRESS AND LOCATTION_I----J 74*2�-----"---/XY/9 /7..---- -a-� '�',/,�+ ------- e � -- - Phone. Owner's Name--------- __ ' y � ,n Address------_--- 47/_0_51---•--- Contractor's Name----"-.---/ " o�----- -------• ---""-"-- -" ---- -- - ---- � " - --- Phone"----- --------------------------•- Installation will serve: Residence [1�- 'Apartmenf House ❑ Commercial ❑ Trai4er Court ❑ Motel ❑ Other ❑ A-- Number of baths __ .. Lot size -- Number of living units: _/--- Number of bedrooms _ _..� /��¢��---�---�" """-"---�-- - Water Supply: Public system U?-Communify system ❑ Private ❑ Depth to Water TaUe�,P_ ft Character of soil to a depth of 3 feet' Sand ❑ Gravel [j Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M-l"fdardpan ❑ _.._._.,_..._ } No [T New Construction: Yes � o E] FHA/VA: Yes ��No El Previous Application Made: (if yes,date___ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -Distance from foundation-_.�Q....__..Ma��al/411 !> - ------ --------- Septic Tank: Distance from nearest well_._._.-_.___.._ No. of compartment _ Liquiy - --------Capacity."�p� �------.3 ,f�__--_.- Distance to nearest lot line-_elm_-~--.______ \ Disposal Field: Distance from nearest well-r- Distance from foundat/i�on__ Length of each line__ Width of trench :....................."_.----. Number of lines.__._______ g i Type of filter material_! Id-Depth of filter material__ -.----�-Total length_--_ ------------- ----------------------- Type of ____.Distance.to nearer# lot lisle_._�r.~.-_------ I /Y-- Seepage Pit: Distance to nearest well. .-...._.-_Distance from foundation______ __ �2 q rn If Lam' - Number of pits__. .._.1.__..___.__Lining matenalPr��/`""__... Size: Diameter��_____.. ---Depth _____-_-- t Cesspool: Distance from!nearest well -.--------------Distance from foundation--- ..____-..--- ..Lining material------"-"_--- ---------- al-- s. ❑ Size: Diameter- -- ------- - --- -----:--------..Depth------------ ----------- --------------------.Liquid Capacity--.---------------- 9 Privy: Distance from nearest well....------------------------------__..........-.Distance from nearest building_______.__"--_._________________________� I ❑ nearest lot line ------ ------------ ------- - - - - i Remodeling and/or repairing (de'cnbe):------/V�.�-----��- f ----------------='----------- •------------------------------ - ------------------------------------- ------ I hereby certify that l 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. 'a Contractor) (Signed)----.„ ...... d v f......° -------- Ttle_. -- . -------- ---------- - -- ------ ( 13y. buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system ' elation to wells, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTI D 9 ------------ DATE-- ` 7 --------------------- - REVIEWEDBY-------------------------------�- ------ --��------- -- ----------- --- ----- ------- ------- ------ --------- - DATE---- -�----- ---"-------------------•------ -----•=------ IDATE----- ------------------ BUILDING PERMIT ISSUED-------- -- -------------------------------- -------------------------- Alterations and/or recommendations:------------ ---- ---------------- -----•--------------------------------------------- ----------- ------------------- I ------I-- ------------------------ ------------------ I - ---------------------------------- --------------------------- ! -------------------------------- -------------- ----------------------------------- ------... .- -•---------.........-....... ---------------------.............. ---- ------- - FINAL INSPECTION B - Date --- --- --�---- - " `_" SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.•Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street t stacktan,California Lodi, California Manteca,California Tracy,California r E.H.9 2M 1-67 Vanguard Press