15971 - Laserfiche WebLink

Home Browse Search

`FOR OFFICE USE: _-�/_... .._(f,��/_. APPLICATION FOR SANITATION PERMIT � _ Permit No. .,jS'.(.�. .7/ Z. --- [Complete in Duplicate] _ Date Issued ..__ .5...� ----------------------------------- ..---. - ---------- -------- -M -. This Permit Expires 1 Year From Date Issued Application is hereby made'�io 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 No. 549. 11 JOB ADDRESS AND L t CAThON.. ----E-at -•Gypt'olj----141/'_-�------------------------------------ -- -----------------•-- Owner's Name _._ �r ---_-- c¢f2 _. j -------------------------------------------------------------- Phone . . Address I� ------------------------------- 41 Contractor's Name-- ------ -- � G -------- -- - r�/ ` .. ---✓-- --- C'................ Phone----SA O._/._. I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I ,} � Number of living units: - N er of bedrooms ...Z-1 ,umber of baths ___ . Lot size .___. _ , -----:•-_ Water Supply: Public system Community system El Private E] Depth To Water Table __ dit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe ardpan ❑ Previous Applicafion Made: (If yes,date...............__.-) No ❑ New Construction: Yes ❑ No FHA/VA. Yes [-] No E)TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p icDistance from nearest well--------------_-Distance from foundation--------------------Material-------------------------....................... No. of Compartments___-__--_-.._ _Size--------------------------------Li uid de th------------------ _Capacity tY .....................4 ( �Disposal Field: Distance, from nearest well-1j_ -Distance from foundation../ Distance to nearest lot line----/-40.. Number,of lines.-_-__/ . . _ __ Length of each line__4___r_�'�............Width of french. Z.:�'--_-__ Type of:filter material- _ _ i�-Depth of filter material----1 __��. Total length________________---------_ ___ -- -P Seepagepit: Distance'to nearest weII.1NQ� _ Distance from foundationJ6eter__Z. 2P-'-:---- ®®r l ---- t�-_-.Distance to nearest lot line__...._�E-.____ i'� Numberof pits_._:----.----------Lining matenal_ �4t[1,�. : ----.Size: Depth----�.5 -•----------- �1 I Cesspool: Distance from nearest well ------------Distance fro' 'foundation__.-----------------Lining material_-.-----__--___---_.__________,_._-. ----___--Li uid Ca aci als. II �1.1`� ❑ Sue: Diameter------ - ----------------------------Depth--�:.:�=----.-=-:-••--------------------- 9 P tY•---•---------------........g Privy: Distance from nearest well------------------------ --------------------------Distance from nearest building---------------------------------......... ❑ Distanc hlto nearest lot lie---------••--- iRemodeling and/or repairir (describe):-- -----------•----------------------------------------------------._.....-----------•------••--•------------....._..-----.---------------••----•------- •...•------------------ --------------------------------------- ----------------------•--- ------------------------------- ----------------Ij-----------------------------..-----•-----------------------`----=------------------------------------------------------..._....----•--•------------------------------------ d I ------------------------ --------------------------------------------------------------------•---....--------•----------- -------------------••---•------....------------------------------------------------------------------ hereby certify that I Have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to law nd'rules and regulations of the San Joaquin Loc alth District. �! 1 [� I [Signed - it ] { Contractor By: ------- •etl� [Title)---------------- ---...... (Plot plan, showing size of I t, location of system in relat' to wells, buildin , etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED IBY---------------- -.z.c ------------------------------------------------------ DATE----------q---e P-_.0,X.......----------- REVIEWEDBY-_-------------------J------------------------------------------------------_---------------------------------------------- DATE-: BUILDINGPERMIT ISSUED A----------------------------------------------- --------• ----------------------------------------- DATE..,------------------------------------ Alterations end/or ecommendations: .: - --------------•-----------------------------.-------•-•---•-------------------_-------.-_--------------. -. - IM ----------.-..- -------------- --- ---------- .� ------------------------------------------------------ •--------------------------------------------------------------------------------------------------- I SIN -- ----------------------------- - --------------- -----------------------------------------•-------------• -- ----------------------------••------•--------------------------------- -•- -------------•....... FINAL INSPECTION BY::._ Dete__.____--- '2 Q ` E' ---------- --- 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 i, ES 9 REVISED a-59 2M 5-6Z ATLAS