16257 - Laserfiche WebLink

Home Browse Search

�fOR OFF, E USE: ` APPLICATION_ FOR SANITATION PERMIT Permit No. --."-_"-- (Complete in Duplicate) Date Issued ------- - - ----- - __- ---.--- This Permit Expires 1 Year From Date Issued District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health This application is made in compliance with County Ordinance No. 549. s i _/ ----•---- - ---------- -------------"-------------•---------------------------- JOB ADDRESS AND CATION_______`/-. ��---------- -------------- • ------------ Address - Ph one. Owner's Name___ ___ _________ Address------------ - - ----:----- " ---- ----- ----------------- Phone -- Contractor's Name------- Installation will serve: Residence ❑ Apartment House F1 Commercial ❑ Trailer Court 9 Motel [I Other El ' f Number of bedrooms ________ Number of baths _4:31—Lot size ------��"L+-----��•� �- •-------------- Number of living.units. __C•� Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table _VQ ft. Character of soil to a depth of 3 fee+: ! Sand E] Gravel ❑ Sandy Loam [IClay Loam [I Clay ❑ Adobex Hardpan E] Previous Application Made: (If yes,date---------- =--------} No F1New Construction: Yes No E] 1 HA/VA: Yes [:] No E3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from found a,tion__"1d--------Mater�al__ __..__ --p ----------------------------- No. of compartments----a------ Size_��_�5�� _..Liquid depth--_y_r_�_- --Ca acit __.�_y�- �__�______Distance to nearest lot line__,S______--__ Disposal Field: Distance from nearest well__SAD._. Distance from foundation__f. Number of lines-------- _-------- Width of trench------___, ____ ___________Z ---"--"-- ----__" Length of each line/,0,0----------.t--- Type of filter material__Vl�O__ -Depth of filter material___._ _�__.-Total length_______________________ 6 ! ` _.__.__.Dis anv to nearest lot line.___5--------- Q Seepage Pit: Distance to nearest well-1p�__------Distanc m f undation_ Linin material__ -"---Size: Diameter__:_______._--..___.Depth____-----� ------------ fro - ^�( Number of pits_,__.------------ g -- - V1 Cesspool: Distance from nearest well_________________Distance from foundation.-..______________.Lining material____._________________._-__________ ❑ Depth------------------------------- ------------------ Liquid Capacity gals. Size: Diameter__----------------------------------- f Privy: Distance from nearest well-----------------------•---•=----- -----------[]istance from nearest building_____-______._--__________-----_------------------------------------------ ❑ Distance to nearest lot line---------- ----------------------------- -------------------- ( ---- ------------------- Remo eiing and/or repairing,(descxibej: ----- ------ -----•-- ------ ------ -==- ----------- --- --- --------------•----------- ---------------------------------------------- ,fl ^— •� _ -. S.--,e--------------------•---------- ------------- ------ € rr �� --------� - . i I here6 if that I hay epared this application and that the work will be done in accordance with San Joaquin County ordinances, a e laws an r s n d regulati ns of the n Joaquin Local Health Distric+. (Signed) �- ----- ----------- --=---------- caner and/or Contractor Plot tan, showing size of lot, location of systelatian `----------------------- """ -"-`-""" {Title}-.__ ._ ------------------------ By.. --- -- ----- m in { p g to ells,_buildings, etc., can be placed on reverse side). F FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ _ ------------------------- DATE...... -1-�D_-- ---------------------------- it --•----- --.... REVIEWED BY i -------------------------------------------- DATE------ ------------------•------------ ----- BUILDINGPERMIT ISSUED---------------------------------------------------------------- ----------- DATE----------------------------- -- ------ y-------- - --------------- I Alterations and/or.recommendations:--- 'z-- -"- �:.1A------ 1 - � '�'� cale ---•-• v } - -- `'-----------------------------------------------•-----•------------------------------------------ ----- -------- ---- -------•------ ---- FINAL INSPECTION BY:------ - --------- ------------ Date-----85��t-- ....... .....----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California I Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 31A 3••53 F-FXG.