15495 - Laserfiche WebLink

Home Browse Search

FUKUFFICE USE: --------------------------------------------------------- ------------------ -------------------.------------------ APPLICATION FOR SANITATION PERMIT Permit No. f. `------------------------------- {Complete in Duplicate} Date Issued ---------------------------------------------------.--- This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install tL work herein described. This application is made in compliance with County Ordinance No- S49. JOB ADDRESS AND L CATION __.-___.. lad P.. s' ----- - --- _...................... .------------ Owner's Name -- _ / '� -------V-— - ' . - - ---- ---•--•-----•------ `'`°" ne. Address.. "fX--------- "---'"�- �"`C A Contractor's Name_,eV_A_--,kZA-------_-------- ----- ---------- Phone----------------------- Installation will serve: Residence ❑ Apartment House E] Commercial ff Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -An. Lot size ..__ L k-,� _ ____ •----•----••---------- Water Supply: Public system X Community system ElPrivate [3Depth To Water Table ff I!_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam IM Clay Loam ❑ Clay ❑ Adobe❑ Hardpan d Previous Application Made: (If yes,date____________________) No M 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_Sj'06------Distance from foundation__!P--_.___._--Material___ t.. •---__ �- P ° No. of compartments---' ------------------SizeltY' E--, ....... Liquid depth---•y------------------Capacity_�.�--�"p Disposal Field: Distance from nearest well_iS�' ---_ O' NJ Distance from foundation../__.._..___.__.Distance to nearest,lot line.___..___-. W ;kINumber of lines--------- Length of each line_.-----3 w1!- -- .Width of trench.---3{ ._- --------------- I Type of filter material.-A?4_.Depth of filter material.... _ ---------_Total length.. __-.-•-------.- Seepage Pit: Distance to nearest well__17P�Q'_------Distance from foundation---/4'_.._____-Distance to nearest lot line_-ic....PO Number of pits__;-----------------Lining material--- v€4---------.Size: Diameter----'' '•----_- Depth__ ._...--• ___-- T. Cesspool: Distance from nearest well--------------___Distance from foundation,-------------------Lining material-------------- _.____....____._-.� El Size: Diameter--------------------------- - ,s---De fh-=---------y------------- ------------Liquid Capacity gals.' ( Privy: Distance from nearest well-------------- --- _ -----------____---------------Distance from nearest buildingiS ❑ Distance to nearest lot line.---- ----------------------- - . Remodeling and/or repairing (describe):--------------------------------------------- --' ---•--------•-•-•----•---------•--- ----------------------------------------------•-------- -------•----------••------••---------•-----------•------ •------------------ per, -----•-•-------- ------------------------•----------•----------- -- . ---------- •-------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and r gulati of he Sa Joaquin Local Health District. (Signed)- (Owner and/or Contractor( BY: ------------------------------------------------------ --------------------------------=------------------------• - Title (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 ACCEPTED REVIEWEDBY---------------------------_------------------------------------ --------------------------------------------------------- DATE--- •----- BUILDING PERMIT ISSUED------------------------------------------------------------- ----•---•--- DATE---- - -- ----•-------------------- Alterations and/or recommendations:------------------_------------------------------- ----------------------------------- -•---------------------------------------------- -•------------------•------------------------------------------------------------------.---------------- ------------------------------------------------------------------------------------- ------ --------------------------------------------•--------------------•-------•--•--------._---------•-------------- •------------------------------------------------- FINAL. INSPECTION ------------ Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street ^4 124 Sycamore Street Y 205 West 9th Street Stockton,California Lodi,California Manteca,California L Tracy,California ES 9 REVISED S-S9 2M 5-62 ATLAS