15934 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �� o♦ ----/ ' -APPLICATION FOR SANITATION PERMIT Permit No, --------1.. � (Complete in Duplicate) Date Issued -------------------------------------------------------- This Permit Expires 1 Year From Date Issuedr 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 Wd � e No. 549. JOB ADDRESS AND CATIO .- . .....� ------------------------------- / _�/ ---------------------------------------------------•............. OwnersName--- --- ------•- ------------------------- ------ Phone-•--------•----...........-•-------- y _ __.p��- Address. = = -------- Contractor's Name :, ---------- Phone..----------------- Installation will serve: Residence r partment-House❑ 'Commercial ❑ Trailer, Court [IMotel ❑ Other El Number of living units: Number of bedrooms--. Number of baths Lot size _,� _f .............................. Water Supply: Public system ❑ Community system PR"'Frivate ❑ Depth To Water Table A&IV Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ .Clay ❑ Adobe 2"OH"'ardpan ❑ Previous Application Made: (If yes,date-------- y No [I?-* New Construction: Yes ZJ—No ❑ FHA/VA: Yes Pg.—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e SeptTank: Distance nearest well __-_ -------Distance �romndation--�,1_•`--- ---.Mate�el... a��G -------- u5_11" _--•-• dd" Noof comparfm ts ----------------- Liquid depth___,. _ Capacity_-_--___._ 1 ______ Disposal -Field: Distance from nearest well--- r ------Distance from foundation..M!......Distance to.nearest lot line_-1!--.--- Number of lines----___ __f ength of each line____/ � Width of trench__ _ _______________ Type of filter material __l Depth of filter material__ --------Total length___, __a- ----------------------- Seepage Pit: Distance to nearest well------_-'"--------Distance fr m foundation---/p__-------Distance to nearest lot line_4�71---- ®� Number of pits----2............Lining mateSize: Diameter-_. . .........Depth_ 2-:0 ................. Q Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- Size: -__-.---•------- _----____-----_- Size: Diameter--------------------------------------Depth----------------------I-----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------ ---------------------------Distance from nearest building-------------------:--____---------_---.-. ❑ Distance to nearest lot line---------------- ------- Remodeling and/or repairing (describe) Wi -------------------------- - - ---xI --••--------------------------- `------------------------------------------------------------------------•------------------------------------------------------------------------------------ ------------------------------------- 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 + an Joaquin Local Health District. (Signed.. = -------------------------- ne Contractorl. BY:-------------------- - --------------=---------------•-------------------------- ----- {Title) ' • .................... --------- ' (Plot plan, showing size of lot, locetion of system in relation t ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ___._ REVIEWEDBY------••---------------------- ------ -•-----•---•-------•--------- .................. DATE_,-----•-•---•-------••---------------- ------------------ BUILDING PERMIT ISSUED...----.....T . Alterations and/or recommendations:.. -. t.... -�...... ---------------•-•--•---------- - --------•---•-----------------------------••-------•----------•----•----- -----------------------------•-•--- ............ .................•--._.....................-.----•-------•---•----------------------------------- 7 T ------------------------------------ - ---=----------------••--------------------- ----------------------- ------ ------- --------------------------------------------------._.....---------------------------._--------•-- FINAL INSPECTION BY: ------ --------- Date-Zrn1a ---------------- SAN JOA IN LOCAL EALTH DISTRI 130 South American Street. 300 West O Street 124 Sycamore205 West 9th Street Stockton,California ', Torii,California Manteca,CallTracy,California ES 9 REVISEO a-59 2M 5-52 ATLAS