16921 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------------ -- APPLICATION FOR SANITATION PERMIT Permit No. ._...._ ._.. / (Complete in Duplicate) ill/ 1 Date Issued ..._..___ _._.-�?-- ----- --------------------------------------------------- This Permit Expires 1 Year From Date Issue_ r J l Application is hereby made to the San Joaquin Local Health District for a permit to con$truct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND --/ LOCATION- --- � -------------/540 --- "" Owner's Name----l✓�1.�t.2-Z.� - x -z _'''------------------------------------- ------------------------- ------------ Phone----------------------------------- ,t I Address—_----------ef._..�-------.. ---------------------------------------- -_.-------------------------------------- •----------------------------------------------------•------- Contractor's Name-------14 - -�i� "'-----------------•--------------------------------------------------------------------- -••--- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f----- Number of bedrooms I___ Number of baths er__ Lot size ------- ------------------------------------- Water --Water Supply: Public system ❑ Community system ❑ iPrivate [� Depth to Water Table ?'r ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date___ _______________) No New Construction: Yes. No ❑ FHA/VA: Yes E] No ❑ m TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ � __.---- �__t___-___-._.______.Septic Tank: Distance from nearest well_ )0_______Dista fro foundation___. 4 ___ ______._Capacity--./ , /No. of compartments..______ _____________Size' _ t ___Liquid de th Disposal Field: Distance from nearest well_:-4___-----Distance from foundation__/P-------------Distance to nearest lot line- ® Number of lines------ r______ --------- Length of each line---/�-___.______-_.-_.Width of trench--_�-�9-____-_-__----______ of filter materia.. >'%Depth of filter material--_/y-------__.-_Total length--�---------------------------------- Type Seepage Pit: Distance to nearest wel_.__, O=D__---___Distance from foundation __'____-._-_.Distance to nearest lot line__-_--_._--_.. J Number of pits-�_--_____._____Lining material_ : '_ .. Si,,: Diameter-----3,3---=_____-Depth--- .�------------------ t Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----_.________.____.._..----_--_--__. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_4-------_---------_--------------I------- ____-_Distance from nearest building ❑ Distance to nearest lot line-------- ------------------------------------- ---------------------------------------------------------------------------- -------- ------- Remodelingand/or repairing (describe]:--------------------------------------------------------------------------------------------------------------------------------------------------------- � --------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.. --------------------------------------------------- ----------------------•-----------------------•-----------•------------------------------------------------------------------------------------------------- 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)----------- - -------- -----------------------------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------ ------ - -- - - ----- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY --------------------------------------------------------- DATE-- ��d �' �` ------------------------ - REVIEWED -------- ----- ------ - REVIEWEDBY---- ---------------------------------------- ------------------------ DATE-------- •------------------------ -------------------- BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE-------------------------------------------------------- Alterationsand/or recommendations---------------------------------------------- - -------------•-•------------------- ---•-----------•--•-------------------------------------------------------- -------------------------------------- ---------- ------------------------------------------------------- ---------------------•------------------------------------•---------------------------------------------------- Date--- / . FINAL INSPECTION BY: -------- - b SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.CD. T