20656 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ..----------------- ----------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. �5--__-_ --------------------- (Complete in Duplicate) �. . -------------_........_______________... ___________ 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 scribed. This ap licatigpyi made in m�plian a with County Ordinanc eNo. 549. �- t � �/ if � -------------------------------- - - JADDRESS AND OCATION.______ � -- -L___L-_�-'---��_:_.'_..<_=L�� --------- Owner's Name- y � !--- ----------- - -----�----- pone C? - '�a Address -------------------------------------- / -. Contractor's Name-------------------------- - � ��-------------------------------------- ----- - ------- ----------l= --------- Phone----------------------------------- Installation will serve: Residence Apartm t House C] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___t<____ umber of bedrooms --- Number,of baths.-- lL�ot'size ________ ______________________ ---------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 7-____ ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe 0 Hardpan ❑ N 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.) Sep.ic Tank: Distance from nearest well____. ____Dista fro foundation__-..__l__ ____Matri yy _ ll ------ No. of compartments________________ __Size"... _l__,X__,5__.___Liquid depth------'7"-_.�__ __-_-capacity_l� �_.__-W Dis oral Field: Distance from nearest w'11 Distance-from fountion-_ _n7eg_ _ _.Distance to nearest lot Number of lines___.______�7�-_____ __________Length of each linL�_'_:`_� _= � _ _.Width of trench_._ .___________ 1XJ Type of filter material___ 1 � `+depth. of filter material,__�_..f____._ ..Total length___.___2-_ _:-7 Seepage Pit: Distance to nearest well----------------------Distance from foundation-------_---------.-..Distance to nearest lot line__.__.___________ -Linin material-. -- -Size: Diamete.r________________ ❑ Number of pits----------------------- 9 ------.Depth--------------------------------- Cesspool: Distance from nearest well ___________._-Distance from foundation---.---- .__:-_.Lining material____________________ ❑ Size: Diameter--------------------------- '-Depth = _-1--n-Liquid Capacity_. ._ z._ ._:..gals Privy: Distance from nearest well_ __ _ _____ _ ____ .___ _________Distance-from neare _building------------------------------------------- El .____ _________ _________ ..____- r ❑ Distance to'nearest lot line -------------------=------=-------------------------------`----------------------- ----------------------------------------------- Remodeling ------------------------- _ -------- Remodeling and/or, repairin '.(describe):------- T --------. a ------ ------------ -- - - -- -= -- ++ =*C.. T ---------------------------=-------------------•---------••-•----•---•-----•------------------------ ------ ._.....---••-- -- --- -•--------•--------------•---------------- --------------- t I t- i _ _ ---- ---------------------------------------------------------i-----------:-----------------------------=----- --------------.-----•----------------.------------------------------------_.------------- 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. y.,_1 ,�/1 ,� - J I : (Signed).._='�1' —._L'� 1 =[ � 7 �lGt --------------------------------- c (Owner and/or Contractor)_ . (Plot plan, showing size of lot, location of system in relation to wells,.buildings, etc., can -be placed on reverse side). • � I FOR DEPARTMENT USE ONLY it APPLICATION ACCEPTED BY---- -------- ----- =------- -------------------------------------------- ----------- ---- DATE---- —------------- REVIEWEDBY--------------------------------------------- ------------------------------- -------------------------- T _- DATE-`'=-�-� �'�—�� `---------- BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE------------- ----------------------------------------------- Alterations and/or recommendations:-----------------------------------------------------------------------=-----------•----------•-------------------------------------- ------------------------ -----------------•------------ -•-------------------•----•--- ------------------------------------------------------ --------------•----------------... -------•-------------------------------------••---•--------------------------------- --------------------------------- FINAL --------------------- ---------FINAL INSPECTION BY----------- -- -------- --------- Date---------------- * `f ------------------------------- 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 6-59 3M 3-'63 F.P.Cp•