13983 - Laserfiche WebLink

Home Browse Search

FOR f�OF�E USE ------------- APPLICATION FbR SANITATION PERMIT Permit No. .. -_�. :' r -------'`-"-- fj ------- (Complete in Duplicate) ) Date Issued . -..-. --.-` ,CU.�-----/Gi/- This Permit Ex ires 1 Year From Date Issued v� VApplicatio i �rrlade tot S Joaquin Local Health District for a permit to construct and install the work herein descrbed. 1,T-Kis applicati is, adegn.,co �an ,with,County..O.rdinance.No.,549. M JOB ADD LOCATION._.--- • .- . i _? , -----U--- --..---•-- -•- -- E Owner's Name------- -< r -;...��...................-- Phone..l� ...... � F Address �' '. ...... t 2 �i ..........................................-........ -= ` Contractor's Name----- .......f ..<. ._....,C ...... .......................••--•-•--•-------•-------------------- Phone................................. Installation will serve:-ResidenceE❑Apartment~HousexO-Commercial-0- ommercial0- Trailer-Court-❑-Motel•❑-Other ❑ Number of living units: ...Number of bedrooms .._ % Number of baths ...I Lot size ._..s, .�x__�..�.. ... ........ r.. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ r Previous Application Made: (If yes,+date-------------------I No New Construction: Yes ©-90 [] FHA/VA: Yes ❑ No ❑ . TYPEk OF INSTALLATION AND-SPECIFICATIONS: (No septic,tank or cesspool.permitted if public sewer is available within 200 feet.) Septic Tank:._ Distance from nearest well --------Distance from foundation-----1 ?mt, Mafierial-, ........... I No. of compartments----------0--------------Size_l3_X-_GI__----sT_".Liquid depth-----------------------Capacity. --.�a2� Disposal Field: Distance from nearest well-. --_Distance from foundation-10Distance to nearest lot line_t ® Number of ------------------------Length of each line---- ---------Width of trench------ '�-_"_.-----------....... Type of:filter material..X.4--4!.K-------Depth of filter material----1-'7............Total length------rZ�--_._--••----------------- ' Seepage Pit: Distance to nearest well---------------_.----.Distance from foundation...........---------Distance to nearest lot line................ . Number of its.....----F "`I=iFi ferial-------------------_-.Size: Diameter._-__.-.------- ❑ p' g Depth :.._ Cesspool: Distance from nearest!well�_-ts.._......_Distance from foundation--------------------Lining material------------------------------------- 1 ❑ ---. P --------- ---------------------Liquid Capacity----------------------------gals. Size: Diameter--�--------�--- '�--------•---..De th-----------•-------= � Privy: .4Distance from Weare ! ell------------------------------------------_--.-Distance from nearest building---_--.-----_--_-----___..._----_------.-. ❑ Distance to nearest lot line ""- ------------------------------------------#-- ---•----•-- .......................................... Remodeling and/or repairing )descY 5_e) ..---------- ., -----------•.............•-•--...-------•--...-----------•----------------------------•-....--- ---------------------IN --------- --------------------------- ------------------------------------------------------------------------------------ - -•--------•--•--•••-•-------•........... -•-------•------•----•--•-----•-••----------------------------------- ->•� �' � - - it _ �.,.�,�...' -..,.�',. I hereby certify that I have preparedhis application and that the work will' be done in accordance with San Joaquin County ordinances, Sta laws, and rules and r,g_-ations--of the San=Joazquirs Local Health District. ' (Signed)- --:--cC---- 1(---` -- f .t � --- ------------------------------------------- ----(Owner and/or Contractor) B .:. .. _-• .=.....:.•... .............. Title y-•-•--------•----------------------------------.= - -_�.....-- { ) (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 APPLICATION ACCEPTED BY--=J- ------ --`-" ----------------------- DATE----�� -x..� ------------------------ REVIEWED BY.. - ------------------- DATE ----------------------- ...................... BUILDING PERMIT ISSUED-------------------------------------------------------------- ------- DATE------------------------------------ Alterations and/or recommendations: ------------- ._ ----- - -- �-----"-"--, .•--e ---� � �-= --- -} ----------------------------------------------- ---------,...... 'Ge - ter..-- . ��'.. ti It FINAL INSPECTION BY j,1----- ....... ------- Date---- - --- ---- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EC 9 REVISED 8-59 2M 5-61 ATLAS r ro