17630 - Laserfiche WebLink

Home Browse Search

FOR OFFIC c USE: _ d ?� -------- --- --,- ----------- A APPLICATION FOR SANITATION PERMIT Permit No. ...... .. - -------------- s---------------- -----.-------- {Complete in Duplicate) �, Date issued --------.±1-��---� This Permit Expires 1 Year From Date Issued y -- 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 o. 549. is w f JOB ADDRESS LOCATION.......�- - ------ ------ ------------•------------------- -----------..... -- ------------- Owner's Name-- .0 Address - --------••-•-------------------------------- Contractor's Name ---------� -•------------- ---------------------------- Phone_ "l�!�� -•-- ------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Tr2:*10tLsize rt ❑ Motel ❑ Other • Number of living units: -------- Number of bedrooms ________ Number of baths, .� ------- ---------------------------- Water --------------------------•- Water Supply: Public.system ❑ Community system ❑= Private Depth to Water Table/1 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeDd Hardpan ❑ 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 Tank: Distance from nearest we1l-S7?�___fi_Distance from foundation_3_40........ Material__--_ .-V---------------- t No. of compartments------ . __Size_3_X�_1�__ ------------Liquid depth__, -. ____-.Capacity----� - �-�•� Disposal Field: Distance from nearest well-. —11 -___-_-._.Distance from foundation-_/,O___-._-___Distance to nearest lot line---------- Number of lines------------ ________ __ ____n__Length of each line---�/�.9_-__-_- _-_-Width of french......-�_�__�-------__-_-- ,w - Type of filter materiel_Sc_ /GK -Depth of filter material___ ______-__Total length----------- __1Q_4__________________ Seepage Pit: Distance to nearest well--_-__-______-f____--Distance from foundation------------------.Distance to nearest lot line----------------- 000 ' ❑ Number of pits--------- -----------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------. Cesspool: Distance from nearest well_____*_--___-_ __Distance from foundation--- El material___.-.____________-_-----_.__-______. ❑ Size: Diameter--------- ---------- - --------------Depth--- ------------------------------------------------Liquid Capacity--- -----------------------gals. r _Distance from nearest building Privy: Distance from nearest well-------------------------------------------- -- g ------=--------------------- ❑ Distance to nearest lot line. - ------- ----------- -------------------------------------------------------------------------------- . Remodeling and/or repairing (describe):_ _ o {!— �{: 7 ________F-___ ________________________________.___ 1 -- y�'.`{ UU ---------- t ---------- # -- ------ -----------------------------------------I-----•------------------- F 1 I-------------- -r—---------------------------------------- ------------------------------------- --------------------------------;__---------------------------•-------------------------- I here rtify that I have prepared this application and that the'work will be done in accordance with San Joaquin County ordinance Sta a laws, and tules and regulations of the San Joaquin Local Health District. t (Signed)----- �,�--- --- - ------- - - ---- ---- ----------- --------------------- Owner and/or Contract wn d/o or] By:------------------------------------------ ------ - --- ------�-----------------------{Title} .. €-. { (Plot plan, showing size of lot, location of system in re o wells, buildings, etc., can be placed on reverse sidel. FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY-=-.--------=--------------- - -----------------•----- ----------------- DATE REVIEWEDBY------------------------------------------ ------------------------------------- -------------------------------------------- DATE---------------------------------------.-------------------- l - - DATE--BUILDING PERMIT ISSUED--------------- -- - _ h i -----------Alterations and/or recommendations:_ -- ------ ------ -------- ------------- ------------------------------------------------- ------------•-----------•----------•-- , ------------------------------------ ------------------------•-------------- --------------------------- ----------------------------------------------------------------------------------- -- ------------------------------ -------•------------------------------------------------------------------------------------- ------------------------------------------------------ - FINAL INSPECTION BY:..�-_- -- - -- ------------ ----- -------.._-_ Date--77//7/- -------- - ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISCO 8-59 31A 3-'63 i.P.Co.