18242 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....1 _ -------------------------- --------- -- ---------------- (Complete in Duplicate) Date Issued _ 4/4..... ----------------_----._..__"_""____-_-_-______-____.___ 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 ir}� �liannce with County Ordinance No. 549. oo( —Zoo r-3b JOB ADDRESS AND LOCCATION_27 _-:". - :__r" a!1 _._{_. r - --------------------------•-------- Owner's Name---- �P'l' ?? ................... ......... ......_-_-_- --------""-"------ - Phone----------------------------------- Address............ ------- --Address..---------- = I etc ----•--- :"`-�•"'-'-'A-------------------------------------------------------------------I - —...---........•----------•-----------------__.-_-- Contractor's Name-----e --------------------------------------------------------------------------.--------------------•------- --------------- Phone------------------•-•--•----------- Installation will serve: Residence [�j Apartment House ❑ Commercial ❑ Trailer CourtMotel L3Other [-]Number of living units:_______ Number of bedrooms _ "_ Number of baths _�----- Lot size ____q t__!_,�L,&________________________________-___ Water Supply: Public system ❑ Community system ❑ Private.M Depth to Water Table _?--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made. (If yes,date-----------_------_} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ 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 well_��________Distance from foundation__/4�"----------- Material- =V _"___ Q ] No. of compartments__ L-------------------Size__'?` _4 _r ----------Liquid depth____ ------------------Capacity_1� ______.___ Disposal Field: Distance from nearest well_._O'........Distance from foundation_f4'..._________"Distance to nearest lot line_4"r__________ ] Number of lines------Y--------------------------Length of each line--_--�a-------------------Width of french-.r'—'_.q--------------------------- ZType of filter materialA.X�_Q,,^'/_--__Depth of filter material___/.rt_-------------Total length---141)------------------------------- toSeepage Pit: Distance to nearest welt---------------------Distance from foundation------------------. Distance to nearest lot line----------------- E ❑ Number of pits----------------------Lining material--`-------------------Size: Diameter-----------------------Depfh--------------------------------- Cesspool: Distance from nearest well-------------_---Distance from foundation--------------------Lining material----------------------_... -.-_--_ ❑ Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_____________________-______-"._--_----... ❑ Distance to nearest lot line--------------------------------------------------------•"---------------------------------- Remodeling and/or repairing (describe ---------- -----------------------------------------•---------->-------------------------------- --------------------------------------••--------------- -----------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- --- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, an ru s and regulations of the San Joaquin Local ea�rict. (Signed)------- - --`---- — 1 ........... and/or Contractor) BY-------------------------------------------------------------------------------------- -----------------------------------------------(Tif le)--------------- f (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., canb`e placed'on reverse side). FOR DEPARTMENT USE ONLY Y� , ,c, ---------- ------ DATE__p_-3 0 APPLICATION ACCEPTED BY-.�--x''= -- � ------- -- -------------------------- - ----------------------------------------- REVIEWEDBY----------------------------------- ---------------------------------------- ----------------------------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------- ------------------------------t-------------------------- DATE----------------------------------------------------------- Alterations and/or recommendation s:_ rt .......... r ----------------------------------------------- ---------- ---•------------------ --•-----------------------------------------------------------------•--------------•--•---------------...----------------------------------•---------------------------------------------- ---------------------------------------------------- -------------------------"-------"--------------------------- ------------- ---------------------------------------------------------------------- ------------------------------•------------------------------------------ FINAL INSPECTION BY:- . - - -!' ? ..- ----------------- Date_'` ?"-----------------------------_----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street y Stockton,California Lodi,California Manteca,California Tracy,California t ES 9 REVISED S-59 31A 3-•53 F.P.CC.