17398 - Laserfiche WebLink

Home Browse Search

- F OFFICE USE: r - � ; ----�`�� j _ ------------- _- -- APPLICATION 'FOR SANITATION PERMIT Permit No. ___- :.i r, f ----------------------- - ----------------------------- (Complete in Duplicate) --- ----------------- -- ----------------- --- This Permit Ex fires 1 Year From Date Issued Date Issued ----- Application `SApplication is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r JOB ADDRESS AND LO TION. 7H ` == - . I--z'?---------------------------------------- Owner's Name------ t-�r----------IZA = Phone - "` Address---------------- �-------...------------••---�'_��=�"-�'--�---•--•-•-------------------------•{------------------------ ------------------------------•---•-------•--- Contractor's Name = .1 ' --------------- Phone. z6C --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer lCourt ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms _!`j__ Number of baths __ '-__,�ot size _-_L_ -:C :`_____________________-__ Water Supply: Public system �' Community system E] Private E] Depth to Water Table _� ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob*N- Hardpan ❑ Previous Application Made: (If yes,date--------------------) No` New Construction: Yes ❑ No m FHANA: Yes ❑ NoX 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______-__________.Mafierial___.--________.__-.-_______.____.___-.__--._____. ❑ No. of compartments-------`---- ----------Size---------------•-------`----------Liquid depth-----=--------------_----Capacity-----------------------_ k Disposal Fiel = Distance from nearest well'?Z az_e-.Distance from foundation._./- ---------Distance to nearest lot line--_�_'------- 4 J i Number of lines____ -__l.-. rSg? r - Length of each line ------ - ------------- Width of trench =. e/Type of filter material{=_s_`_gC'�'cLC_-Depth of filter material__-___1`' _f`____.Total length_________________ _�__;------_-,- Seepage Pit: + Distance to nearest well�Zr`"�t-_l'___Distance from foundation---_'__`.....Distance to nearest lot line-.-"A-,- __-_-_ r1 Number of pits------- ------------Lining materia{ 1<_-Size: Diameter._- _-___Depth---_----�Z�`---_____--- - Cesspool: Distance from nearest well_________________Distance from foundation---------- ---------Lining material-------------------------------------- El ______--___-______-___---_-______-..❑ Size: Diameter--------------------------- - --------Depth-=----------------------------------------- --------Liquid Capacity----------------------------gals Privy: Distance from nearest wel!-----------------------------'-----------'__:___Distance from nearest building ❑ - Distance to nearest lot line----------------------------- --------------------------------••••----------------- - --------------------- ------------------ Remodeling and/or repairing (describe):-----------G�G _ -----------------------------••--- --------------------------------- -------- ------------------------------------------------ --------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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).- - `. ------ r [ .c� °'��` ' --------------------------- � � � �-" � --------------------- caner and/or Contractor) l ----------- ---- By:-----------------•-•.-'tee= ___4 z- ' le ,, =------ ---------------------------------------- (Title) i (Plot plan, showing size of lot, location of leystem in relation to wells;buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACC OPTED BY C° - Y---------------------------------•--------------------- DATE---- . REVIEWED BY = -------------------------- DATE - BUILDING PERMIT ISSUED --------- ------=--------- ` ------ DATE--- - ----- ----------- --- ------------- and/or recommendations`:_3_:�1-lt'- - __--. -L.____- __.jtllSc. _Y�---�________. ____-2 £ ----- st �� _ --- -------------- --- -- ---- .. j I I I --------------------------------- FINAL INSPECTION�BY:-. .--� --------- ------ ........... Date '. ry SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street E Slocklon,California Lodi,California Manteca, California Tracy,California 9 E5 9 REVISED 6.59 314 3-'6bF.P.ra. - 5