17707 - Laserfiche WebLink

Home Browse Search

= FOR OFFICE USE: a2—6 ---------------------`--- j '______________________ __ APPLICATION FOR SANITATION PERMIT Permit No. __�__7_ .4.- - ------------------ ------------- -------- --------- (Complete in Duplicate) ------------------ This Permit Expires I Year From Date Issued 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 applicaf.ionris_made,inrcomplianceiwith County Ordinance No. 549. ov JOB ADDRESS AND LOCATION -- -----------•-------------- 1 Sit �� -_ - Owner's Name- iy------ ' � ,, 1-�- Phone------------------------------------- Address............ �_-- -_ - --------------------------•----•-----------------------------•---------------------••----------------- ---------------------------- ff Contractor's Name__ t U.-• _� �!. --c� G £ =- Phone_`1&.f?__.'_3�S -f�_�___ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units: ________ umber of bedrooms -Number of baths I-_- Lot size -Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table 1 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ -dobe 2----Hardpan ❑ Previous Application Made: {If yes date._.____.._.__..__.] No E] New Construction: Yes E] No FHA/VA: Yes EJ No ElTYPE'OF 'INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Distance from nearest well_______________Distance from foundation--------------------Mate rial---------------__ No. of compartments-------------------------- Size--------------------- -e-Liquid de th______--_. --- - _Capacity T?rpo�63) i Distance from nearest well-fq v-_Distance from foundation__/e___------Distance to nearest lot line______ Number of lines-_J--- Length of each line__ .g P �s q- 9 K -------------Width of french -�- r Type of filter material_ _1e_ --Depth of.filter material_______1 lfTotal length______________________A__0--__-___ epag it• Distance to nearest well-___ .f _-__Distance from foundation-- _�^i_�______.Distance to nearest lot iine-----;77— Number of pits-4------------------Lining mate ria l_ �_r,�___.-_-.Size: Diameter____ f l_._-..Depth_..._ _,"!______ - Cesspool: Distance from nearest well-_.-----------._-Distance from foundation___-----------------Lining material------------------------------___`___1\� ❑ Size: Diameter------y-----------------------------Depth---------------------------------- -----------------Liquid Capacity_---------- gals. l --Distance from nearest building Privy: Distance from nearest well----------------------------------------------- Distanceto nearest lot line- - ----------------------------------------- - --------------------------------------------------------------------------------------- ------ Remodeling and/or repairing (describe)----- -------------------------------------- -------------------------------------------------- ----------- -----------------------------•-----------•------ � ,•. - -----------A -------------------•----------------------------------------- ---------------------r-•--------------------------------------------- ,2�,� -- ---•--------------------••------- ---------------------------------------------------------------------•--------------------------------------- --------------------------------------------------------------------------------- ----- 'f 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. (Signed)----- ---- - . . Cr -------- - --- ---------I---- -----------------------------------------------ePQWM_R� �forContractor~lc� By:--------------------------------------------------`--------------------------------------- (Title)------ -- ----------------------------- - L' (Plot plan,'showing size of lot, locations of system in.relation wells,.buildings etc.;can be placed on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- T ------ ----------- ------------------------------------------ DATE------- = REVIEWEDBY------------------------------------------------------------------------------- ---•----------------------- DATE BUILDINGPERMIT ISSUED------------ --------------------------------------------------------------------•-------------------- DATE. Alterations and/or recommen io s --- -- - -__-.--- ------ - ----------- - ---- ---- ----- ` -----C------------------------------------- ° ---------------------- ------------------------------------------------------------------------------- p _ FINAL INSPECTION BY:.. -7 _ !�C� Date-•-- ------ =---- --- SAN 6SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED B-59 3M 3-'63 F.p.CO.