15110 - Laserfiche WebLink

Home Browse Search

FOR OFFICE ------------------------------ APPLICATION FOR SANITATION PER IT ` Permit No. -�-- Z-e. --------------------------------------------------------- (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 perrriit to construct and install the work herein described. ThigiZ s mad pliance with County Ordinance No. 549. t � , JODAND ATItJN -r.� -�, / l `� C_Wsf� �- Owner's Name---- / Address-------- ,. -. Contractor's Name__ �. F_- -- --- -_- --- -- ------------- Phone./&...1 7" 1 Installation will serve: Residence [Apartment House ❑ omrnercial Trailer Court Motel Other E]�/' ❑ ❑ Number of living units: .-/.. Number of bedrooms _-`/ Number of baths f �.�ot size Water Supply: Public system ❑ Community system ❑ Private�_Depth To Water Table%1_Z.7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ;;Clay Loam ❑ Clay ❑ Adobe 4a-IA'a rdpan ❑ Previous Application Made: [1f yes,date--------------------I No ❑ New Consfru�ction': 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.) is tT :I Distance from nearest well_________________Distance from foundation....................Material___-___-.____________----------- No. of compartments--------------------------Size----------.------.----------.--_Li Liquid de th--------------------------Ca Capacity �6r q �P. p tY osa i d Distance from nearest well_ _ -�_____Distance~from foundati n..,.©___--------- to nearest lot Number of lines...._ dd ` --_--Length of each line--- -tE-------��----Width of trench---�►.4- //'...... �^ Type of filter material. -_-Depth of filter ma"terial----./�__--.____Total length-------------_...._____f[�0________- (n Seepage Pit: Distance to nearest well__-_-_Distance from foundation.-----, .......Distance to nearest lot line_______- J 4ANumber of pits:___!:__"___________Lining material__ mC. __.__.Size: Diameter__� ! __"_Defith2 `_______________ S Cesspool: Distance from nearest well_________________Distance from four'dation-~_-__------------ Lining material__._____._.._______-_....__________-_ ❑ Size: Diameter- -------•--------------------------Depth---------------------- --------- ---------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well__________________ -----------------------------Distanceffrom nearest building__._______-___-___-._•_-________.___-_-_-- ❑ Distance to nearest lot line--------------------------------- a = .� ------------•---- ------------ ----- Remodeling and/or repairing (describe),:__ -- '"~�'_ Y -----•-----•---••------•----------•-•-••--••---------- ------------•------••----------•-•----•------------•----------------------------------- I hereby certify that I have prepared this application and that the work_wilLbe done in accordance with San Joaquin County ordinances, State la and rules and regulations of the San Joaquin cal Health District. s (Signed). `'�--._ '. ---------------------- ( f�r�antractar) /� f .. erl Ry:---------------------- -----•.......-------------------------------------------- fJfrr✓�Gl _ _ '_{Title) �-••---•-------------------------- .-.......- ------------- (Plot plan, showing size of lot, location of system in relation t e s, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY.,.,.,.., APPLICATION ACCEPTED BY__j__# --- ------ DATE-----4 --�------- --�-------- REViEWED BY ----------•----------------- `----------------------- DATE------------- BUILDING PERMIT ISSUED------------------- -- -------------- f - -----TE------- Alterations and/or recornmenda+ions:----- -�`' �� - }' -- Y . mac . _--------J C� .r--------- ------------------------------------------------ `1 -- •----•---- --------------------------------------------------------------- ------------------------------------ - -- ------------- -------------------------------------------- --------------------------------------------------------------------------•----•--- FINAL INSPECTION BY: - Date � - { SAN JOAQUIN LOCAL HEALTH DISTRICT I i 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 EM 5.62 ATLAS