17855 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE --------------------------------------3 _ 2 _ -� - --_--._-___________ _____ _ APPLICATION FOR SANITATION PERMIT Permit No. '___�_7 ------------------------------------------ ------------ { (Complete in Duplicate) ------ j This Permit Expires 1 Year From Date Issued Date IssuedS/_-___ Application is hereby made to the S++an Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina ce No. 50. C79r5= 2-70-0(� Z5-! F ? JOB ADDRESS AND LOCATION-- ___ Owner's Name_ 'f P--=__7 ----- -------------------------------------------------------- ---'--- -------------------- Phone------------------------------ ------------------•--•----------------------------------•--------------------•- -•-•----•--•-- ---------------•--.. Contractor's Name-,----- 7� i ---------------------------------------•--. Phone----------- ----•------- - ! Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s Number of living units: __I-_-_ Number of bedrof umber of ba.fhs44 Lot size ---lQ:•Yl ----------------------------- Wafer Supply: Public system .❑ Community system E] Private � Depth to Water Table _P?/P ft, r Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--'Hardpan ❑ Previous Application Made: (If yes,date-__________________) No ew Construction: Yes Vo ❑ FHA/VA: Yes ❑ No [ jti TYPE OF INSTALLATION AND SPECIFICATIONS: SII (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest vie1J_0_-______Distance from fo��urn tion__44----------.Material �%�----------- No. of compartments___-,3------------------Si4Cp�s ` � ze___3_� -- -----Liquid depth---�----- ------- ----Capac,ty-I��'� Disposal Field: Distance from nearest weil�CJ.__---Distance from foundation--%-D---_-___-_-Distance'of.to nearest lot ♦ Number of lines__e..�---------------------------Length of each line_ 7ype,of filter mater _-_______Depth of filter material___/V-_`_____`_____Total length__-Z__60__'---_ Seepage Pit: Distance to nearest well. foo r d ___ ___ _______Distance from foundation _____.Distance to .nearest lot line___________ � I� Number of pifs-_,i L-------------Lining material_�0c-'Ar.:..Si.ze:,Diamefer----3�- -----Depth-------a'�_(S_ ---------------• /n 1 'A - f Cesspool: Distance from nearest wall_________________Distance from foundation-----_--------------Lining material___--___._______-_ ❑ Size:,Diameter-----.- ------------------------------Depth--------- ---------•------------ ------------------Liquid Capacity----------------------------gals. Privy: ,.,..Distance from nearest well--- ----------_-----------------------------_ Distance.from nearest building ❑ Distance to nearest ]of line-------------- ' 3 --------------------------------------------------------------- - l f Remodeling and/or repairing (describeJ:------------------------------------------------------------- ------------•----------------------•------------ -------------------------------------------------------------------------------------- I .w ---- ---------------------------------- {----------•------------------- ------------------•--------•-•------- --------- -------------- ----•---------------- -------•------------------•-------------------------------•---- ---------------------- 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) ------ wner -------- -- --------- ---- -'--------=------ ---'•------ -- - ------(O � and/or Contractor) Y ` C ---------------- ---------------- -----------------------------------------(Tit (Title) --- ------ °-------- ------------ -- -------------- (Piot plan, showing size of lot, location of system in relation to wells,.buildings,.etc.,-can.k'e placed on reverse side). . _ FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY -- - --------- -- -- --------------------------- DATE-------- I- !� REVIEWED:BY. -- -- i - ---------------- ----- -------------------------- ------------------ - --- DATE__ _ - -- - - -- -------------------------- BUILDING PERMIT ISSUED-------------------- _ ATE -------- Alterations and/or recommendations:__- -- �/- _•_-.:--- -- ---- ---- ------------- ----- -- --- - -------- ------------- ------------------------------------------------------------ - ) - ------_-____°___________________________________-- ----- . - _--.____-_-------------------------------- .------------------ I -------------------------- _______________"-.____._--__-----___--__-.____-.-..___-____._._ ---------------------------------- ------------------ 5' FINAL INSPECTION BY:.-_-;_ - -- Date <� l� SAN JOAQUIN LOCAL+HEALTH DISTRICT 1` ,. 1601 E.Hazelton Aw• . 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I ES 9 REVISEo 8-59 3M 3-'63 Fr,P.QO.