15537 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION OR SANITY TION PERMIT --------------------------------------------------------- (Complete in Duplicate) • Date Issued .......... . .�_ - This Permit Expires 1 Year From Date Issued ''" © ��3 — (eD/ 2 d Application is hereby made to the San Joaquin Local Health District for a permittoconstruct and install the wor erein described. This application is made in compliance with County'Or ante No. 549. , JOB ADDRESS A D OC TION c ] a 9 - � Owner's Name.. ---------------------------- Phone..........-•-•--------------. Address-------------------- - --v9 .------ --- / Contractor's Name ��- Phon e0-7------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other /❑ Number of living units: _ -_ Number of bedrooms _t2.__ Number of baths _-/_ Lot size .... a �_ ---!s '✓ ------------------ Water Supply: Public system ❑ Community system ❑ Private 0 Depth To Wafter Table I& ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ HardpanX( Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: T_j I_ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f l /D4 F rA 1� Septic Tank: Distance from nearest well- �-_--: Distance from foundation_ --Q---------Material_ -- ------- - ----------------- P -- ----- No. of compartments---------a:�-----------Size-_. 54...�r�.,�:__.Liquid depth..... �...._--Capacity___.. l6.P. ._ f Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. J ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------------------------_ . Type of filter material--=-----------------------Depth of filter material......................Total length----_-__----_---__-_---.----_-_--_-----.-_ Seepage Pit: Distance to nearest well/-Q1O__"__`__Distant m foundation.-��-�....DistancA to nearest lot line.�104i.. -_. Number of its. --Linin Q material- .G Size: Diameter-_3 ---Depth---- S-._--.....I....... , Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.-------.--_---------_---_ p ❑ Size: Diameter --------- ------Depth---- -----------------------------------------------Liquid Capacity............................gals. , Priv Distance from nearest well----------------------------------------- -------Distance from nearest building ❑ �' Distance to nearest Iofi Ima------------------------•---------------------- ----------------------------------------------------------------------....-----• ------------ � Remodeling and/or repairing {describe= • �'` "- Q ---f -/-- 4 -----------------•----•----------------------- --------------------------------------------------•--------___---------___----_-------_---_---------_-------__••--•-----_-____ .--.-...-..----..-------- ------------..............I...............I........................ ------------------------------------------------------------------------------------------------------------------------------------------------- .-_-.-.-_•_--•-•.............................•_-_.....-..........._--.....___...-______-_---___--_-_------_-_----__-----________-_-_-----_---_-_-.-.---.--•_-------.----_-_------_-_--..--•-..-_-..-_------_--------------------- J ._----•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ L t 1 heArobi,ly that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinancws, an rules and egula+ions of the San Joaquin Local Health District. (Signed).. -• . --• i' ----------- -------------- ------- - Owner and/or Contractor) I . ---- ------ - - ---- --- --- -- BY- --- -- -- ------ - (Title (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY------------------------------------------------------------------------ fGDATE----------------------------------------- -------------- 1 REVIEWEDBY--.- •------------------- -- -----......--' -------------------------------------------- DATE-------- - ----•-----------•------- BUILDING PERMIT ISSUED........- - • . - - A•TE..........-------- ---------------------------------•-------- --- ------- Alterations and/or recommendations ----- -r - �`''- --- ._CM ..� ' -=------•-------_` /�_. �_ K 1�--------------- r • _ - •_- - y__....•__ - .............................»-------..-.----.......................•---------------------------- --------------------•-•---------.__._........_..•--------------------------------•--------..-.-..------•-------------_--- _.-------------•..-----•------------------------«.. —----.-------...-—-------- -'- '-`v�----}l- ----------•-----__--.----_-.---_.--._..---..---._-....-._----_-••_---__••-.--------.--_------_.--.-_----.-_.--._ -------------•-----•----..._------------------------------------__--.--.____ -- " .. { •�.------1- --....«-----»--•.---- -------------------------------------------------------------------------- __- .}�-..-----trl- ----- FINALINSPECTION BY ........................................... --- ---- -• .__ Date------------- ----•----------- -------------------------------------------_--- SAN ---------------- _---SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strout 205 Wort 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS