18768 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- ---------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .... ......... ..... ------------------------------ -------------------------- (Complete in Duplicate) Date issued --- - ----------- -------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to r.uct„and-install the work herein described. This application is made in compliance with County Ordinance No. 549. � •- / � [ co JOB ADDRESS AND LOCATION._ .( ---- --W------ ---------- - - - ----- ------------------------- { Owner's Name.------ ---•---- -- -- - ---------- -------- 'X --------- --- Phone ----•----_.---- Address . ..... Z7.. C Contractor's Name.------- --- Phone..----•----------------•- ------------------------------------------------------------------------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: 7____ Number of bedrooms _Y_ Number aths /____ Lot size ______ ____ _ __ ___.____________F Water Supply: Public system E] Community system [IPrivate Depth o Water Table ___-._-_ ft. {� Character of sail to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ i Previous Application Made: {If yes,date--------____--------) No ❑ 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.) Septic ank: ' t Distance from nearest well____,1' ____.__Distance from foundation----.----/_Q__MateriaL__6&)Ifl � %_____._____. Na. of compartments--------- 2------------ Liquid depth-------- ----------capacity------- D� �--f2 Dispos Field: Distance from nearest well___.,.-@_�._Distance from foundation..../_NL________-Distance to nearest lot Iine__57.___.-_- Number of lines---------- - Length of each line-----7P-Z--------------Width- of trench_____ /r______w:_-___:__' `j Type of filter material_______ Depth of filter material____/___G___�� Total length Q_;__. - f / 9 i Seepage Pit: Distance to nearest}well----------------------Distance from foundation-------------------Distance to nearest lot line-------'-_____-- � ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth------------------------------------ Cesspool. Distance from nearest well---_-------------Distance from foundation- __________.Lining material_______________.____._________`_� i Size: Diameter-------------------------------------`De th----------------------------------------------------Liquid Ca aci ---------gals-. ' ------------Distance from nearest building Privy: Distance from nearest well------------=---=-='----'--==---- g----------------------------------�-- ❑ Distance to nearest lot line------------------------------ ---------------------- -------------------------------------------------------------------------------- -_--- 1 Remodeling and/or repairing (describe)---------------------- ------------;-----•------------•----------------------------------------- ---------- --------------------------------- _ a; - p� -------------------------=--------------- -•--------------------------------------------------------- ---------------------------------------------- ------ --- : I - = ------------ -----•--- ------------------------------• ----------------------------........-..------------------------------------------------------------------- -• --------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- - .� I hereby ce ify th t i have prepared this application and that the work will be done in accordance with San Joaquin Cdunty�� ' ordinances, Sta law , nd rules and regulation's o the San Joaquin Local Health District. F (Signed) ------- ---- r -- ---- - -------- -------------------------------------------------- d/or Contract s r _ $Y=---• lea ----------- -- ------------- ----- ---------- --- - -- - - ------(Tit{e}--------- - ------ - -------- - ---- --------- �- [Plot plan, sho g size of lot, lacatian of system in relation to we , buildings, etc., can be placed on reverse side). -FOR DEPARTMENT USE ONLY A APPLICATION ACCEPTED BY ---- ---------------------------------------- DATE--- -T a__4,-5----------- - REVIEWEDBY---------------------- ------------- ------------------------------- ------------------------------------------ DATE........ --------------------- • -•--------•------------ BUILDINGPERMIT ISSUED----------- J --------------------------------------------—------------------------------------- DATE--------- ----------- -------------------------------- Alterations --- - Alterationsand/or recommendations:---------- ----------- ----------- ------------------•---------------------------------------•----------------•--------•--------------------------------------- -•------------------------•------------------------------------------------------------------------------- -------------------------•-•-------------•----------------------------------•------------------------------------0 ---------- ----------- ---------------------------•---------------------------------------------------------------------------------------------------•-•----------------------------•------------------------------------•-•. ----------------------------------------------------------- --------------------------------------------------------------I-----------------------------------------------------------------_-------------------------------- ------------- ---- ---------- ----------------------------------------------- FINAL INSPECTION BY:. ._.-!y _ --------------------- Date-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 RCVISEO 6-59 3M 3-'63 F.P.CC.