15541 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ----------- -- --------------- - ----------------------- Permit No. .. APPLICATION, FOR SANITATION PERMIT ------------ ------•--- ------------------------------- (Complete in Duplicate) -- --- This Permit Expires 1 Ye'�r From Date Issued Date Issued 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 Ordinance No. 549. s�- JOB ADDRESS AND LOCATION._.. ------kdr....... ........... ....... . Owner's Name---111-9........ s _.. .. A L-{-E-r?' Phone.TZ---- -AddrAddress............. ess------------- Q '--------RA--------2_7-(at------------------ AA--e.V-------------------------------------------------......................-.................................. Contractor's Name-----------ID---- /q= 1f .R=� O-�V.S------ � �------------------- ............... Phone. ---? .------- Installation will serve: Residence Q" Apartment House ❑ Commercial E] Trailer Court El Motel ❑ . Other El Number of living units: __1___ Number of bedrooms . -- Number of baths Jam_ Lot size ___/:4 _._ef2mQ.'_____________________ Water Supply: Pubiicisystem ❑ Community system ❑ Private 0' Depth ro Water Table.29p� ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: [if yes,date___________________) No [R' New Construction: Yes ❑ No [' FHA/VA: Yes.❑ No E!r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic TanD� ,�.,k: Distance from nearest well-----------------Distance from foundation-------.------------Material..___________-________-__--_----_______________- No. of compartments--------------------------Size---------------------------------Liquid depth-------------------------.capacity------------------.- Disposal Fiel Distance from nearest well___-200_.'.---Distance from foundation___45_:a_....---Distance to nearest lot line-----j-._._.._ Number of lines...........,(---------------------Length of each line_______/ T ----------Width of trench---._--____�V_------------ Type of filter material..._._ Pit____Depth of filter material...../._.4F_----------Total length-------------/_A?0_'.............. Seepage Pit: Distance to nearest well----------------_----Distance from foundation.....:..........•_-.Distance to nearest lot line--------------- ❑ Number of pits----------------------Lining material----------+-----------Size: Diameter------------------------Depth----......-------.....----------. Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material--------------------------......... .. ❑ Size:.Diameter--------------- -----------Depth---------•------------------------------------------Liquid_.Capacity....-------------------- Privy: --------------==Privy: Distance from nearest well_=____-_ _________________________________._Distance from nearest building------_---------___.___.___________-_-.-. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---- rJ -------- X./.t✓ .: ::•--------------------------------------- ......................--- •---•---------- .. ----------------------•----------•----••------------------•-------•---------- -----------------------------------•------- --------------------------------------- P��-- ---------------- -•--••------------------------------------------------------------------------------------------------------- r 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 and regulations of the San Joaquin Local Health District. (Signed)----------- ----- -------------------� Owner and/or Contractor l -__ B : - r Title `-- (Plot plan, showing size of lot, location o system in relation to wells, buildr ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- - -- - ----------------___------------------------ DATE-----------.--- f � ---•-- REVIEWED BY--------------------------------------------------- - -- - - - --- DATE------- - r BUILDING PERMIT ISSUED---------------------------------------------------- - -------------------------------------------- DATE --..- Alterations and/or recommendations----------------------------------------_....-----------•--.---------------------------------------------------- ----------------------------------------- --------------------------------------------------------------------------------------------- --------------------------------------------------------------.....------------------------------------------------------------ i I -----•-------------•-------•--- --•--•-------------•-------•--•------------------------------------------------ -----------------------_.._...._.-.-•------.._......._..---- ....-- --------------------------------------------------------------------------------------------------------------------------------------------------•-•-------------------------------------- ---.----------------- ---------- ----------------------------------I------------ ------------------------------------------------------ ------------------------------------------------ --------------------------------------------------------- ---------------------------------------------- FINAL INSPECTION BY________________ ____ -------__-•- -- ---- ----- Date_.._-_ .__ - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Syriet 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS ,