15123 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: dp I s:/:_--.. ___ � - APPLICATION FOR SANITATION PERMIT Permit No. __......-_ .......... � --------------------------------------------------------- (Complete in Duplicate) ------------------------------------ - --------------- --- This Permit Expires 1 Year From Date Issued Date Issued ............. 4 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 r49. JOB ADDRESS AND LOCATION �%f%// =------------------•---•-----------••------------•--_----__-----........--•-- 3 Owner's Name . --•-- ---------------•---------------------------- ----- ----•--•--------- ------------------- Phone------------ .........------- 7�b. Address Contractor's Name---------------- �� -. Phone................................... Installation will serve: Residence''} Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...... Number of bedrooms ___- Number of baths __Ze I_ot size ...�/. ..C .t Tom.................... Water Supply: Public system ❑ Community system ❑ Private -_Depth To Water Table Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ^i Previous Application Made: (If yes,date--------------------) No K New Construction: Yes Q, No ❑ FHA/VA: Yes ❑ N)itZ. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well__ a-_r__ Distance from foundation Zd__..._._...__.Material___ - r^-C---------- No. ------_"No. of compartments �y ______Capacity P 2,- --- ..Size---------•x---9-•--...:_..Liquid depth----��-�------------- P Y----•--------�'--�r Disposal Field: Distance from nearest well%--'---...-Distance from foundation____`-_r_______-Distance to nearest lot line___---------__.._ Number of lines------------ __k -----------------Length of each line____ A`----------------Width of trench.-A--y-g________ _____ Type of filter material.__. __44_--_--_Depth of filter material-_alSl___p_____ ___-Total length______f4 .�________________________ —> S p t: Distance to nearest well_f�a_�____-______Distance from foundation-__t f?.�_.._..___.Distance to nearest 1 line_____________ Number of pits_____:r�________Lining material �C_t>�-----Size. Qiameter_____ _.4_____.Depth___ '_�_________________ See a Pi Cesspool: Distance from nearest well-----------------Distance from foundation_---._- ------Lining material__-_______-________________________ + ❑ Size: Diameter__---------------------------------Depth-------------------------------------------------_._Liquid Capacity__......................gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building------------.____________________________- . ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------- ---------------------------------------- Remodeling and/or repairing (describe) -NIN- - `-------------------------------------- ---------------------------------------------------_--- ---•---•--- ----------•---------------------•---------- r -----------------------------------------------------------------------. ----------_------------------------------------------------------------------------------------------------------•----------------------------------- I hereby certify that I have prepared this application an that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatio;,nelafion Sa Joaquin L cal Health District. (Signed)-------------------------------------------------- -•-------•----- - --- -- -------- ---------------------------------------------------------(Owner and/or Contractor) By:_----------------------------------------------_--;systO --- --------- (Title)--------•--•---•----------------- ------- e ------ i -------------------------- -- [Plat plan, showing size of lot, focatio of to welts, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY t-� # a 4 �1 APPLICATION ACCEPTED BY------------- :; ------------ •---------------------•-----------•---- DATE-----} ------ REVIEREVIEWED WED BY--------------UED----------------------------------------------------------------------------------------------------- DATE--------------------------------- ----------- Alterationsand/or recommencrations-------------------------------------- ------------------------------------•----------••-------_--------- ........................._----------------------- �.. ---•-- ---A C--- ----------- • --'-�- -- -/� -------------- - - -- ---. -. —---------•-}------------------------------- ,d -------------------•--••--------------------------------------- -------- -- -------- •------------ ------- --------r----------------------------------------------------------------------------------------------------- ------------ ------------------------- ----------------- - .- — Z ._--.. ..... FINAL INSPECTION BY: D - -------------------------------------- iioate- v SA J AQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS