17794 - Laserfiche WebLink

Home Browse Search

R OFFICE USE: - ------ ------- --------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ .7..71..�. --------------------------------- ------ ----------------- {Complete in Duplicate) --. . --- This Permit Expires 1 Year From Date Issued bate issued �l1c-rte 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 AN LOCATION. ' S <---7-21---------- � t.. ✓� QS � ' - �Owner's Name------- ------• -------��-- � --------- -. Phone.=-7_e� -----•--••-----------r 1F Address-----•--------------------_. _-s-, Contractor's Name---------------------- ' ---------------------,-- / \ Phone---------------------------------� i Installation will serve: Residence �( Apartment'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f__._ Number of bedrooms ��_._ Number-of baths Z___ Lot size ____ Water Supply: Public system ❑ Community system ❑ Private 19' Depth`to Water Table/--3�__�_ ft. Character of soil to a depth of 3 feet:- -Sand ❑l Gravel ❑-Sandy Loam)N [I ❑ [:]� Clay Loam Clay Adobe Hardpan ❑ �� Previous Application Made: llf yes,date"__ -____. _r___._1 No ❑ New Construction: Yes ❑ No FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND, SPECIFICATIONS: ' f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pti ' Tank: Distance frominearest weft-----------------Distance from foundation--------------------Material------------------------------------------------ r No. of compartments-------------------- -----Size- ---------------------------Liquid depth--------------------------Capacity---------------------- Disposal field: Distance from nearest well. - Distance from foundation �A___..---.Distance to nearest lot Number of lines_______ ar_ _✓! Length of each line --------------Width of french....... ------- Type of filter mae _____' _- De th of filter material __ " ----- _-.-._-_-triai___ � -- --___Total len _ _____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____-________.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------------------- r Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------.____.____________- y ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------_-_------- Distance --- - Distance to nearestllot line = ---------------------------------------------------------------------- ¢. Remodeling and/or repairing (describe),---------------------r-----------------------------------------------------••------------------- -----•--•-----------------------------•--- -------...__. 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, St to laws, and rules and regulations of the San Joaquin Local Health District. , (Signed)... � �- `j P'.-r---Pem -------- -------- ------------------ -- F<-- ----------- ------------------V� , owner and/or Contractor) BjWY ------- ----- �- — -•- Title[ } � (Plot plan, showing size of lot, location of sy3n relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- e-------- L A, ---------------------------------------------------------------- DATE-----' ' REVIEWEDBY--------------------------------------------- --------------------------------------------------- ------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------=-------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------------------------- ------ -------------------------------------------------••-----•--•----------•---------•-------•-----------------•-•----------- FINAL INSPECTION BY --.- '� ------ -------------------- - Date--- q - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.Co.