16534 - Laserfiche WebLink

Home Browse Search

OR OFFICE USE; ��- -- ----------- 3d-------- Permit No. .. v APPLICATION' FOR SANITATION PERMIT ., - -----------------=------ - [Comt)plete in Duplicate) Date Issued ---If h- - - This Permit Expires 1 Year From Date Issue ---------------- --------- ----------- 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. -•--ho--------- ------------------------- JOB ADDRESS AND `OCATION____�j�- CC- �3,.� "-------•------------------------ -------------------- Owner s Name____ ____ _ ______"---- - - Address ¢ �+ ------------------------------------------------�-------------------•-------------•---•-••---------=---------------------- } Contractor's Name L - ------------------------- _ ------._. Phone----------------------------------- ------------------------------------ will serve: Residence [A—Apartment House ❑ Commercial ❑ Trailer Court ❑�rMotel ❑ Other ❑ Number of living units: :-1 Number of bedrooms .Number of baths ._-_. Lot size _h-(.� �--7 -- Water Supply: Public-system Community system C3 Private E] Depth to Water Table _ Gft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 5an .y Loam E]."Clay Loam ❑ Clay ❑ Adobe [Hardpan 11 Previous Application Made:. (if yes,date-----_--------------_) No ew Construction: Yes F1Noj?rFHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No seVic tank or cesspool permitted if public sewer is available-within 200 feet.) Septi k: •Distance from nearest well_________________Distance from foundation------.------------Material____._______----__.______._.---_-___.______----. No. of compartments----------------- --------Size---------------------------- ---Liquid depth------------------ -------Capacity.------- f Dispose Field: Distance from nearest well_.._' -----Distance from foundation__ �J ----Distance -to nearest lot line / Number of lines--------- ------------------------Length of each line---L� Width of trench_- - f! De th of filter materials "_ " rt Total length-------_=310----------------------- N Type of filter materia__rbc/ .- ---Depth Seepage Pit: Distance to nearestwell-- --__Distance from foundation__/-&-----•---Distanc to nearest lot line----------------- W Number of pits______/------------Lining material Cesspool: Diameter " Depth - --'---------- b Cesspool: Distance from nearest well-----------------Distance from foundation-----.------.-------Lining�maferi`al�._.._..---------- ------`- els. S ❑ Size: Diameter-------------------------- -------- Death------------------ - -------------------------Liquid Capacity-------- -------------g �.y Privy: Distance from nearest well----------- ------------------------------------Distance from nearest building----------------------------------------- I Distanceto nearest lot line-- ------ ----- ----------------------------------------------------------------------------------- '^ f y ______________________________________________________________________________________________________________ v Remodeling and/or repairing (describe}:__.-_._______---_____.________._-____-- ---------------------------------------------- -------- --------------------=-------------- -- - -- - --------------------i--- -----------------------•---------------------------------------------- I hereby certify thaarules ed t s application and that the work will be done in accordance with San Joaquin County ordinances, State laws, eg tions of the San Joaquin Local Health District. Si ned (Owner and/or Contractor) -----------------(Tit -------------------------- ------- -- --------------e}- (Plo# plan, showing size of sys min relation #o wel{s, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•- )_.--- DATE------ - --`-- -- - ---------------------- REVIEWED $Y------------ ------- ---------- ------------I ------------------------ ------------ -------------- ----- ---- --•--- DATE------------------------ a!�i_.•�_ . [`U_3_. l` !�"..s.----- - --------------------- -------------- -------------------------------- -----"-------- – ---------- ----- ---- ' E----- �----- r- ---------- BUILDING PERMIT ISSUED---------------------------- f ,/c - --- --- --- Alterations and/or recommendations:------ ------------ --------------------------------------------------------------- -------------------------------- --- ------------------------------------- . -----•------ - 7 FINAL INSPECTION BY:------ --"---------------- Date---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street . 205 West 9th street Stacklon,California Lodi,California Manteca,California Tracy,California ES 9 REV196C 8-59 3M 3-'63 F.P.CP-