17538 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; f I ------------------------ --- ------------------------- .! APPLICATION FOR SANITATION PERMIT Permit No. . ---. --- ------------ --------- ----------------- ---- ------- (Complete in Duplicate) This Permit Expires 1 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 h rein de c i This�applicafion is made in complian with County Ordinance No. 549. i I 'kik a Q-4 = ----- ------ JOBADDRESS qDj LOCATIO z"` Phone:Own is Name--- ----------- ame-- ;Address--- _�--- - ----------- aContrctor`s Name--------------- --- ---•- - ------ - ---- --- ------------ •----------------- Phoned.--_---•---- Installation will serve: Residence Apartment House ❑�/Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I �'"_._ Number aths ___�_._ Lot size .---- Wat�,Number of living units: __.____ Number of bedrooms ___ - ------------=r--- - •------------- --'- Supply: Public system ❑ Community system ❑ Private Depth Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ZClay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] iIl: Previ ous Application Made: (If yes,date-----------,......--1 No E] 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.) I Septic Tank- Distance from-nearest well-----------------Distance from foundation----------- _ .Material_==.- --�F-__:_______-=______--- No of eomparfinents------ Size-------•------------------------Liquid depth------------- - GapacitY #. i " 10 ill Dispgs Field: ,._Distance from nearest weH...;�®_--;._.Disf�nce from foundation----/P----------Distance to neares# lot Ike________________ 1 - # J1-J ,, j e i _,,,,,Number of lines' :_-._t_ . _____ ___Length of each line -_:��------------------, Width of trent .�-�,-�__ ___Depth of filter material---- .T g Type of filter matenal__� t - - p - - tai len th,__. Q_ - ___________ �Se'epage Pit: Distance to nearest well______________________Distance from foundafion___.___________.:__.Distanceo-nearest lotot}line::,.____.__._____ a Number of pi#s------------------ ---Lining material ---------------------Size: Diameter-----------------------Deph-` ---_--------- --�--- O p ----------------- th---------------------------------------------------Li_Liquid Capacity--- ___-------�-----Wi Fess ool: Distance Diameter}m nearest well ______ ___Distance from foundation----_..___._____._..Lignin material .__-___�_-__- ------ s. d I 1 � Privy Distance from nearest well------------------------------------------------- from nearest building.__!I�------.__________--_F___.. _ --- 0 Distance to nearest lot line------------------------------ ---------------- ------------------------------------------------------- I� - -------- `�-Remodeling and/or repairing (describe)___________________ ; ---------------------•--- --•------------------------- ---------------- ---------------•------------------••------------------------------ ------------------------------------ .11-------i--------------=---------------------------------- -------------------------------•--------------- I ---------------- ----- .1 hereby certif at I have prepared this application and that the work will be done in accordance withl San Joaquin County k ordinances, Sta aws nd rules and regulations of the San Joaquin Local Health District, ry� (Signed)----------- - ---------------_- --- _ n or,Contractor) C9.� -----------------------L - --- ------ ------------ -- w ,� z I ----------------- -----._........' By: --------- -- (Title) (Plot plan, showing size of lot, location of system in relation to its, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY .II APPLICATION ACCEPTED BY_ --- 6 / D ' - -- --- -- -- - -- ---- --- ------- ----------- -- ------------------------------ DATE-- -- -- - ------------------------- REVIEWEDBY------------------------------------- --------------------------------------------------------------------------------------- DATE----------------------0--------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DA•TE----- ----------------gh------------------------------------ Alterationsand/or recommendations------------------- -- -------------------------------------------------------------------=- ----••--------------------- ----------•--------------------------- I '��I------------------------------------ -• ------------------------------------------------------------------------ ---------------------------------------------------------------- --•----------------------------•------------ - ----------------------•---------------------------------------- -------- -------------------------------------------------- - ----------------------- -------------------------------,III --------- { -------------------------- _ � -� FI;jNAL INSPECTION BY:. '' ' =*`r' - ------ Date------ .--/-- ------ - ------- I------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1J 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 20 West 9th Street �l� Stockton,Colifornia Lodi,California Manteca,California Tracy,California ES 9 REVISED 93-59 3M 3-•63 F.P-CD. -