21197 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------ ----—-----: 11 14 - -------------------------- - ---------------- APPLICATION FOR SANITATION PERMIT' Permit No, zl_ -------------------------- ----------------------- -. -- I (Complete in Duplicate) 4 Da Issued -------------------a-------------- -------- This Permit Expires I Year From Date-issued Date .......... This Application is hereby made' 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. OB ADDRESS AND L 11 -�P7o 04"-(. P� QCATION---------------------- -------------------- ......4W...........g _J - ------- --- --- ............................. Owner's N --------------------------------------- --- Phone..-�jli Name--------- ............................. Address------- --- --------r- ----------- -- . ....... . . ------ ...... ... .... Contractor's Name - 11 -- - ------------- .- A(__-Z 6 ---t _ '-----•---..........------•-------------- ..... . ............................ ------- P h Ot_. Installation will serve: Residence [-I Apartment House E] Commercial E] Trailer Court ❑ Motel 0 Other Dir Number of living units: Number d 'S r of bedrooms .-CL Number of baths - __-r.. N -------- Lot size ......��b_ ....................... Water Supply: Public sysfe I M ❑ Community system E] Private Wr Depth TO Wafer Table &,ft. Character of soil to a depth of 3 feet: Sand [:] Gravel [] Sandy Loam E] Clay Loam IN Clay [-] Adobe [] Hardpan C] -- Previous Application Made:: (if yes,date-------------- -----I Nog) New Construction: Yes JET'�No D FHA/VA.:Yes Ej Nogr I TYPE 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--------------------Material--------- ----------..................... 11 N o. of compartments-------------------------Size--------------------------------Liquid depth-------------------------.Capa"city----------------------- Disposal Field: Distance from nearest well__--_-.I--------Distance from foundation_---_------------Distance to nearest1lot line............_.... ❑ Number of lines_________________________.____-_-_Length of each line------------------------------Width of trench-----I............................. Type of.filter material_------------- Depth of filter material-----------------------Total length------------11------------------ ------ i __ Seepage Pit.. Disfance'.fo nearest well_____ ---t-Distance from foundation....-_.tqt - _Distance to nearest'lot line..-_:4,Number' Number' 'of pits._____.----------Lining maferiaI___Q#1 __414ze: Diameter._.__---ed Cesspool: Distance, from nearest well-----------------Distance from foundation--------------------Lining materiaL. ---------------------------- El Size: Diameter----------------------------------_Depth----------------------------------------------------Liquid Capacity-----11-_------------------gals. Privy- Distance from nearest well------------- -----------------------------------Distance from nearest building______-_--- _______-_-.__--__._______.._. ❑ Distance to nearest lot line----------------------------------------------- -------------_--- Remodeling and/or repa (describe):-----_---S 7'-0-4-��- tPV.......424J--------C&I------ ..... .............................. --------------- -- ------.-L- -L--- --------------_----------- - ---------- ------------- -------I-------- -_ ----------------------- ----------------------- ------------f--------- ----------- J .... .................................. ....... ------------ ........IKZ.I rQ-- -------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- f I hereby certify that I ha ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws. and and regulations of the San Joaquin Local Health Distrid. (Signed)..... L__- ----C Lk------I...... ---------(��------------------------------•--------------------------(Ownier at I d/or Contractor) By: (3C -------------x------ --------------- ----------------------------------------(Title)---------- ---- ----- ------- (Plot plan, showing size of lot" location of system in relation to wells, buildings, efc., can be placed on reverse sidiel) .I it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED;BY----C__5-' --- ---------------- DATE.... /,0 -------------------- --------------------- ------------------- REVI=WED BY -------- ---------------- DATE ------------------------ ------------------- BUILDING PERMIT ISSUED-A------------------- VM......... DATE.-----r -------- ---------------------_------ Alterations and/or recommeAdaf ions:--- --------------- - ---------------- - --- -- --- ------ ---- --------- ------------ ------ r ---------- - -- ------------------- ----------- ------------- ---------- --- ... -.-....-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.......--- ------ ------ - ----- - - :.. ------------1-1----------- -- J---------------------------- FINAL INSPECTION BY-------------------- Date.-------------��.1--.�..��-6 SAN ate_------------ SAN JOAQUIN Lo,.Rt- HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 Wast, 9th Street Stockton,California Lodi,California Manteca,California Tracy,C.alifornia ES 9 REVISED B.59 2M 5-62 ATLAS