16648 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 4 } __ -.�-7 __>p-• ----------- ---- _ APPLICATION FOR SANITATION PERMIT Permit No. _-- • - - ---� ---- -------------- (Complete�r1-- (Complete in Duplicate) /1 3 ! y- Date Issued ____ ________ ________--_°�-�_- This Permit Expires 1 Year From Date Issued i -app ication is hereby a e to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is e . o la n with nt rdinance No. 549. ��,Sf - S AD A CAI N1K, ff/�' - '' ------------------------------------- JO > - ''� Owner's Name Q � � - --•---------------- - ------- Phone-------------------------------- J Address----------------------------- ------ Contractor's Name--------__ - Phone_.. Installation will serve: ResidenceM'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: j------ Number of bedrooms-__ Number of baths _----- Lot size: � r: 'z�� ------ Water Supply: Public system .❑ Community system ❑ Private Depth to Water Table&.'eft. Characfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San -Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes [Ro o ❑ FHA/VA: Yes [] No ©� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_...lp----.__.__.Distance from foundation-l-:__f___-- aterialL� G�__u_r_�G_ ... r No. of compartments------ -------------Size__ �_X� __:...Liquid depth%_>: ------------:Capacity._.__ta ------ (} Dispos,/al �Id: Distance from nearest well -_�.._Distance from foundation_ ___!.'__ ---.-.Distance to nearest lot line,�_�_...__. Number of lines__._ - Leng th of each line ---------.Width of trench-Y- ------------------- ls 5 Type of filter material-----�%��_------Depth of filter material_.,..._..-_:.__Total length__ _/-_---_---__ Q I If Seep^age�It:� Distance to nearest well__/Q'0-------___Distance from foundation—/ ----_----_.Distance to nearest lot line__X----------- Number ---.-__._Number of pits_ -------Lining material__r-C_C ._-.Size: Diameter.-?.�>--------.Dept h_CP_Z_'�_�,1c..r�.,� t Cesspool: Distance from nearest well______'.___._.-Distance from foundation--------------------Lining material__--__----__-_.__-__.____--_._._. G ❑ Size: Diameter-------------------------- -----------Depth------------------`.---------------------------------Liquid Capacity---------I------------------gals, (. Privy: Distance from nearest well---------------------------------------------- ...Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line---------------- -------------- -------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- -- •--- - "-- ,. -------------------------------------------------------------•-----:--------------------------------------------------------------------------•----...--.--------------------------------------------------------------------- ------------------------------------------------•------------------•------•---------------------- ---------------------------------------------------------------------------•-------------------------- -- -------- I hereby certify that I have pre this application and that the work will be done in accordance with San Joaquin County j ordinances, State la s, d rules d reg lations of the San Joaquin Local Health District. (Signed)-- -- ---- ---- -.-�d-- - -�- ------------------- (Owner and/or Contractor) ; By=------------------------------ I .. 1. C1 (Title} --- -- .. f.>✓,t er.;' (Plot plan, showing size o cat on of system in rela ton to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ----------------------------------------- DATE1 ----------------- REVIEWEDBY---- -------------------------------------------------------- ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----- --------------------------------------------------------------------------------- ------------- DATE-------.--------------------- -- --------------- T Alterations . and/orreccom?mendationns:. ... ._ �} --� - _ -------------------- - "/`-------- - ---- ----- - - --- ----- ------/I-----Vic_- -........ f . �.�/_-_"----•.�- - -_�_-----•----- - — ----------------------------- ---- ---------- ,� �---- -ter----------=- . --- 1-t1_67-------------------------------- - -- - ----------- --- ----------------- ------------------------------------ - -------- ---------------•---------------------------------•-------------------------------------------------------------------------- FINAL INSPECTION $Y:. - - = Date-- --- �/__ --�/-��---.�------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 F.Huxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad!,California Manteca,California Tracy,California rs 9 REVISED S-S9 3M 3-'63 F.F.CD.