18160 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------- ------------... (Comple#e in Duplicate) Date Issued ------------- --- _-___"------ --_- .--.--_---.- This Permit Expires I Year From Date Issued ' - - -.---.- Q _ ZtO--tl 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. JOB ADDRESS AND LOCATION.____- --- U = -------------- Owner s Name--------- � � ------------- Ph ----------- l Address l 21C � ----- ---- -------• ---------------- - Contractor's Name X�:'--. -_ Phone----------------------------------- --------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Ceurt-o otel ❑ Other ❑ r Number of living units: ---- Number of bedrooms ---/.- Number of baths _1--. Lot size ._- -__--- -.- -• /-- � e Water Supply: Public system ❑ Community system ❑ Private ©nth to Water Table 17 ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ®Cay ❑ Adobe❑ Hardpan ❑ ❑ Previous Application Made: (If yes,date....................] No [D--New Construction: Yes r]--No ❑ ❑ No FHA/VA: Yes � TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or.cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well_ _.-------_-Distance from foundation---- - --------Materia f- -..----,------------_ -___ � ©� No.`of. compartments-_-----_�:--____---_Size___ _r\_-7----Liquid depth------------ _..----.- Capacity--.f Disposal Field: Distance from nearest well.---:f L.Distance from foundation--_-1-�7-_----Distance to nearest lot line- --��-_- �J --.---__-_ Length of each line_--.z_=-v_-�d._v7eWidth of 0 Number O Number of;lines--i__-___-- _ Type of'filter.material__- i H'P /Depth of filter material------- _--_--Total length--__------_: --..--_---_- Seepage Pit: Distance to.nearest well___- .-____-Distance from foundation_------.---_'_--__-.Distance to nearest lot line----------------- ❑ Number of}pits "----- -------- ----- Lining material---------- ------------Size: Diameter----•------------------Depth---------------------------_ 7 Cesspool: Distance from nearest wel1_7- ---- ------Distance from foundation....................Lining material-------------------.----------------- ❑ Size: Diameter---------------------------------' Depth-------------�'--------- ------------------ ----Liquid Capacity------------------------ gals. st a Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.------___-_---_----.----_-_----_.__..._. ❑ � � Distarice to nearest lot line-- ---- ��----��--�---------------------------�-�-•-------------- --------------------- ----=---------- ¢ �. c_ i —• Remodelin and/or repairing {describe]:-- --_.. - ---•--------------L 'a ----- ------------------------------ /�` -- „� -. �Ts2 u `--------- - ---- `� z -` �r / JLf •_____ _______.---.-______... -------"------------ -._---•_-_--.- -- ----_�___•-_-- __----------__-_-___-----___.___----_"_____-------------- - I here 'ti that I have pre r his application and that the work will be done in accordance with San Joaquin County ordinances, a nd a gu tions of the San Joaquin Local Health District. {Signed - ------------------------ --------------- -------------------------(Owner-a---n-d---/--o- nd/or Contractor) -----_----- ---- -- -- -- Title By--------------:---------•----------------- •- -- ----------_------- -------------------------------------------------------------( ) (Plot plan, showing size of lot, locat of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � `-¢~'J DATE.-- L - / REVIEWEDBY J - ----------------------------------------- DATE-------- --------------------------------- ------------- BUILDINGPERMIT ISSUED----------- -------------------------------------------------- = ---------------- DATE------- ----------------------------------------------------- 4 Alterations and/or recommendations--------%/. -----= - '�i .. ---- r, ------------ �--`�� G f/ y-�_. c-, C'.�:v t..- - - y---- h`�� --------------------------------------------------- ------------------ ----------- ---------- - ----------- ---- ---- --- --- --------- -------- -------------- ----------- ------------------------- ------------ ---------- ----------------------- FINAL INSPECTION BY .......... .......... --------- ------------------------------ Date .1 ' ------------------------------- SA JOAQUIN LOCAL HEALTH DISTRICT *s 1401 E.kaxellon Ave. 300 West Oak Street 124 Sycamare Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M ?--83 F.P.CD. ti:k�