15763 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- ---------------------------- SE:-----3--------D-- b--- --- -- ? +�� -- --. APPLICATION FOR SANITATION PERMIT Permit No. _.,1�........._ l/ --- ----------------------------------- ------------ (Complete in Duplicate) / 15/,b -------.---�----------------------------- -- This Permit Expires 1 Year From Date Issued 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 appiica4ion is made in compliance with County Ordiinn}ance No. 549. JOB ADDRESS ANAL TION__ 01__-1 •.... + ---f ----- -----------........................................... ..... Owner's Name-------� _ -------------- 2 ----- I -- ------- ••-- --- Phone............... . � Address - � � r------ -01 ........ -' ------------------------------------------ P Contractor's Name._._..- ------------------------------ Phone....-------------------------- --- -------- .s Installation will serve: ResidenceEr partment House ❑ Commercial ❑ Trailer Lurt ❑ Motel ❑ Other El Number of living units: .._L__- Number of bedrooms__- Number of baths ___ Lo t size ____________________________________________________________ I Water Supply: Public system ommunity system ❑ Private ❑ Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Previous Application,Made: (If yes,date----------.---------) No [ New Construction: Y sto ❑ ' FHA/VA: Yes ❑ Noa;l- I TYPE OF INSTALLATION AND SPECIFICATIONS: (No sotic'ta>rik-r-cefspoal p 2 ermitted if public sewer is available within 200 feet Tan IDiSeptic w tance from foundatio ------------------ a7ial.. _r/--C _....... No. of compartments -------------Size...... Liquid de pth__ 7,----------Capacity. ____._. Disposal Field: Distance from nearest welL____r '_Distance from"',foundat�on .. Distance to nearest lot Gne _._._ . . [ Number of lines_....__.w-________"'Length of each line_ __ _.Width of trench- %_______________ Type of filter material..J,Lx_.1ra4eDepth of filtermaterial__ 1___.____Total length_./_ ,�______________________ Seepage�it� Distance to nearest well------- pistance from fourd ___ ___.__ ation _._.Distapce to nearest lot - /e+. -__-___-- C1Nt/ umber of pits____��_____Lining material_.___.____ __Size: Diameter__,. 3-- ---Depth=D I Cesspool: Distance from nearest well-----------------Distance from ❑ foundation----------- i------- Lining materia l___._.____________.____-___-___-___- Size: Diameter-------------------------------------De th---_-----------_---- ------ ------- ----• Liquid Capacity. ..-----••-•----gals. Privy: Distance from nearest well________________________________________________Distance from nearest building----------------------._._.______..____._. ❑ Distance to'nearesfi lot line__.______..__________________________ _ 1--,i r--....... Remodeling and/or repairing (describe ------------- --------- --- -- --- - ----------------------- I i 4''. ..._, . I ----------------------------------------------------------------- ------------------------------------ ---------------------•-••------•--------------------------------•--•----------------------------------•-------------------------..--------------------. I hereby certify a I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, d rulis and gu tions of the San Joaquin Local Health District! (Signed) . _... Q 4 _6r,_)__(Owner and/or Contractor) --------- Title I (Plot plan, showing size of location of system in relation o wells, buildings, etc., can be placed on reverse side). t "�"""'""" " ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B --•---- - ----------------- DATE..,j7— ---- -------------- I ; REVIEWED. BY------------------------------------------------- --- DATE--- --------•----- �': BUILDING PERMIT ISSUED------------------ - ----- ----- --------------------------------------- DATE. --------------------------------------- Alterations and/or recommendatiana: - / � - 49 . ..._ -----------------------------------I----__------ ----------------- ......I-- ------•--------------•---------------------- - --------- FINAL INSPECTION BY:-. � Date----3�-- ------ ---- -----------------•----•--------------••--- 'SAN A4 UIN CAL"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 E5 9 REVISED 8.59 2M 5-62 ATLAS