14008 - Laserfiche WebLink

Home Browse Search

r-. FOR OFFICE USE: --- ---- --- --- ----------------- ------------------------------------ --------------- APPLICATION FOR SANITATION PERMIT Permit No- .l_.615r.... --- -- -------- r ---- ------------------------- (Complete in Duplicate) . Date Issued ---------------------------------------------- ---------- This Permit Expires 1 Year From Date Issued_ Application is hereby made to the San Joaquin Local Health District for a permit to con ruct and install the work herein described. This application-is made incompliance with ounty Ordinance No. 549. ,. , -.� tit- JOB ADDRESS AND CATION-- --- -- --- ----- -- .(i� .!• J .._ ... '' -----------'-------- 0�S--ZSO -o g' Owner's Name---- - W....... - - ---- --- -- --------- --------------- Phone. --......................------- 46 - 't' :..Address-----------------11�P'- A'0 kA Contractor's Name--- ------• - -- ---1---- -------•------------•-•- ----- Phone - - - --- . . Installation will serve, 'Residence ❑ Apartment House ❑' Commercial ❑ Trailer edFt Motel ❑ Other ❑ Number of living units: ___I._. Number of bedroomss�-_ Number of baths _1____: Lot size -2-1 �.��.�.��-�------------- _- .�,.. Water Supply: Public system ❑ f ommA unity system r❑,,Priv�+te Depth to Water Table , ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sar dy'Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,11ate--------------____�] No N Cons+ruction: Yes',( No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seer is available within 200 feet.) SFptic Tank: .Distance from nearest well_.«S'"a------Distance fro foundation.___ __U___.__:Mat riel_.. __ .._..._._._____........................ �� of com artments_._ __ - -----------------Sizer �-= --- P �'- --M--- ; -�---Liquid depth--------...--------------Capacity,.1.�:_�..... Disposal Field: -Distance from nearest well_..1�__0 Distance from foundation.__ld-----------Distance to nearest lot line................. Number of lines__ .-.. Length of each line_-__�%p!_--p- Width of trench._. -�a___________________ ..Tpe of filter material_ .Depth of file material_____:_f L!__�______Tots!•length______----------------------------------- y- rn. Seepage Pit: Distance to nearest wel______________________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----------------------------------I ❑ Size. Diameter-- ----------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- •gal 1 11 Privy: Distance from nearest well______--.__.______--_________________________Distance from nearest building-------__.............._.------------ ❑ Distance to nearest lot line---------------------------------------------------------------------------------k-------------)----•--------•----- 's, Remodeling and/or repairing (descr'iiibe)------------------------------------------------------•---------------------•---............ ............. .J. - -- ... - --•--------. --------- ---------------------------- --------------------------------1---------------- ---------------•-•---•-------•----------------••---------------------:..-------------------•---------------------------------------------------------•-•---------------------•---------------------•----------•-.---------_. ------ -------------------------------------------------------------------------•.---------------------------------.- ------------------------------- ) ------.----------------------•----•---•--•-------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance4S+aws, and r lesand regulations of the'San Joaquin Local Health District.-W _.,(Signed) F��,-_,--- '_-" .__--__-. (Owner and/or Contractor] 1-1 ` - By..-.---- --------- ------ ( )-------------------- ------• --------- .._. -------- --------- --------- ------- --------------------------------------------- - (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY_ _ DATE _�., .'ja ----•---•------•--•---•---• i REVIEWEDBY----------------------------------------------------------............_..----...-----__.-----------......................... DATE................................................... 1 BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------- -------------•-------- Alterations and/or recommendations:----------------------------------------- -----------------------------------------------------•-••-----...---------._...-----------------------------:....---- --------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------•-•--- .•-------•• ---•-•-•------ ---- ---- --------- ---------•------------------------------- -------•---•--•------------•----- ------•--------------------------------------------------------------••------ G 7-� INSPECTIO FINAL N BY: �-a' ----------•- Date--------- --- --- ----------- -----••-- --- --------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.59 $M 5-61 ATLAS