14667 - Laserfiche WebLink

Home Browse Search

-� FOR OFFI E: .. �` TIr a -.-__._.._ ----------- �'� .-_--._-f APPLICATION FOR SANITATION PERMIT Permit [ - ---- ----I-----------------------=-------- (Complete in Duplicate) w " Date Issued --- ------------- Application __ ---------------- ----------------- -------= -- --• This Permit Expires ] Year From 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. JOB ADDRESS AND LOCATION............ Y '/------ ,hdtc Owner's Name......---Ali-........ .... : 'a fir•'- - ----- Phone................................... Address........----- ..�'1-� 1 . ,�cr��tr / -- ------------•------------------------••--------------------- yap Contractor's Name !�� ,�• -r--------------•-------------------•-------------- Phorie.4� ?-. -----•-••--•- Installation will serve: Residence Apartment House E] Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/.___ Number of bedrooms ._Z.__ Number of baths __j-___ Lot size .------Al ___`X-.._�Pa_� Water Supply: Public system r- Community system ❑ Private ❑ Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe .Q' Hardpan ❑ Previous Application Made: (if yes,date--------------------) No 2- New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ '`� 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____________....__.___..____.. El No. of compartments---------------...... -----Size--------------------------------Liquid de ;h--------------------------Caaci Disposal Field: Distance from nearest well-.JVa±1. _Distance from foundation---/?...........Distance to nearest lot ❑" Number of lines---------------L-----------------Length of each line.........._,_,0_ ...........Width of trench______2_�__._._.______.__...__ Type`of filter material..... o_c_Vit..-._.Depth of filter material-----�_j'_."__.____Total length____---_ .`_________________ Seepage Pit: Distance to nearest well---- Distance from foundation-----!__4- .._--.Distance to nearest lot line----S—./____.- P/ El- Number of pits--------._------------Lining materlal_.._,/�-6_s.-/f—_..Size: Diameter-----, �----------Depth--------417_ ._•----------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---.____--____-____-__..._ _ El Size: Diameter--------------------------------------Depth----------------------------------------------------Li uid Ca aci 4 P ty•--------------------------gals. Privy: Distance from nearest well--------------------------_----------------------Distance from nearest building----------------------------------------- Distance ._____--_____.____.-_Distance to nearestlot line.-------- �� Remodeling and/or repairing (describe):--------------------------------------------------------- -------------------------------------------------•-•-------•-------...--....... ------••------I--------------•--------------------•-----------• i _______________._-_______-________-___-____-.._______________..._-__7__-______.__..__._._-____--_---_______-_______----____________ hereby certify that I have prepared this application and that +he 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) - ---------------- -- gY: � -- -------------------==---------------------------•-••• - - - -------(Title)-------•----•-------------------------- ............. ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ti FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY_____ ----------------------------------------- DATE----- l' .. •• -�• -------------------••----------------------------------------------• - BUILDING PERMIT ISSUED------------------------- --- DATE - --------------------------•-•-------- t DATE------------------- •- Alterations and/or recommendations - :__ '-�.- ------------------1-1---------------------------------------------*------------------------------------------------------------------------------------------- .................i------------------------------------- .....................•------•-- ------ ----------•--------• ----------------------------------------------------•----------•---•----------------------------------- --------••---•--- ------•-•---------- •----------------- ------------- -------------•---------- -------- •------------------------------------------------------------------------------•---- FINAL INSPECTION Bi:....... 1. - ---- -- -------------------------- Date----------- t) — -v 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 t ES 9 REVISED 8-59 2M 5-62 ATLAS ,!