15874 - Laserfiche WebLink

Home Browse Search

FOR OFFLE LIST: I r mss_ �- / -,` 41cc ---�--- � -- --- ---- ---- - ------------- �� Permit No. .��4..�• I APPLICATION✓FOR SANITATION PERMIT ------------------------------------------ -------------- (Complete in Duplicate) Date Issued .. S ._Z7 %_3 .............. This Permit Expires 1 Year From Date Issued lF 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 Ordina ce No. 549. { ��jj L --------•- JOB ADDRESS AND LOCATION..._;Z___� 4Owner's Name_ _-m.. -.---- ----.--.-. Phona.. r"...�Z f_��, • Address- -- ~� -------•---•----------------------••---••-••------•-------- ----•- -- Contractor's Name ---• - - Phone.................... ......... Installation will serve: 'Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: rA..... Number of bedrooms ..1—Number of baths -- Lot size ------f,S�X •--------- ---------•�--------- Water Supply: Public system 0--community system ❑ Private ❑ Depth To Water Table ...CO- ft. Character of soil too depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpans 0 Previous Application Made: lif yes,date_.------------------) No [ New Construction: Yes ❑ No B-- FHA/VA: Yes ❑ No ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Materiai---�_ .......--•••• Septic T k: Distance from nearest well__'_-�---___--_Distance from foundation lD__�.____..- . Ur No. of compartments----=?----------------Size------... `.Liquid depth------------ Capacity.....° Disposal eld: Distance from nearest well---___'!------Distance from found __ ation /d-.______..Distance to nearest lot Ii .-__�r7... Number of lines -------------------------Length of each line__...�s-------------------Width of trench.--- .Y_..._..--------_---•- Type of filter materiae -406 -----Depth of filter material___ `•_____...Total length____..�1�..-_•_____________________ Seepage Pit: Distance to nearest well______.` '______.Distance om foundation_...rr' _....__.DD'istance to nearest lot line._ ---- El Number of its.-__ --------------Lining materialQ. -- Size: Diameter--- .... ----------------Depth_____. s................. Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material--_____.__.._____.______.....___-_--- N ❑ Size: Diameter----------------------------- --------Depth-----------------------------------------------=----Liquid Capacity.------••-•--------. ------gals. � Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.-..---------------•--------.------ ❑ Distance to nearest lot line--------- -------------------------------------•--------------••---------••------------------------------------------------•- ------- ------ A Remodeling and/or repairing (descrbe):- f -- �<ti!v1 -- •--------`- -- --- ------------------•--•------••------------- - •- - ------•----------- ----•------------•----•-----------------------•------•-•--•-•-- ------------------•---------------------------------------------------------------------•--------•-----------------•----••--------------------------- 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 an ulat' ns of the San Joaquin Local Health District. (Signed)---------------------------------------- ------------- ------------------------ -------------------------------------------(Owner and/or Contractor) -- Title (Plot plan, showing sae of lot, location of system n relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED B --- ---- --- - -----`----- - ------------------------------------- DATE__ '-- --------. -----------------•---• DATE-------------------- ----- ------------------------- BUILDINGPERMIT ISSUED----------------------------- ----------------------•---------------.._. DATE.------------------------------------------------------------ Altdrations and/or recommendations:.------------------- ------••----•-•-•----•--------------•----------------•--•------•-•------ ----•- ------- -----•----•------------------•------- -----•--------------------- .. / ` ---- FINAL INSPECTION -- - -- - - -------- ---- - -•--•--------------- --- ------ - --- Dafie�>�- .. -- - ai SAN AQUIN L AL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California lodl,California Manteca,California Tracy,California ES 9 REVISED 9-59 2M 5-62 ATLAS