16905 - Laserfiche WebLink

Home Browse Search

F OFFICE USE: �� yM 2- 51 -�1.,____y'~t_o________. APPLICATI6N SANITATION PERMIT Permit No. ../'_.:...,1. .� / d - --------- I r - F �G � (Complete in Duplicate) ,a-� This Permit Expires 1 Year From Date Issued Date Issued _--___.-7.1..�P. ! Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe//d. �1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION t'f L-----=--- ------- ez �, C 3 ........ ...... Owner's Name------- Phone j i/ .. . f Address.------•---•----- /fa =•-f'--�" t � -- .................................... § y `Contractor's Name. : --- -------- - .....--••--•--...--••--......--- one.. _. --------------•--------- Installation will serve: Residence tic Apartment ouse [I Commercial v Trailer Court [IMotel ❑ Other ❑ �''` Number of living units, ____"Number of bedrooms ____ Number of baths 1..... Lot size --.�..7, =..___ .... ...................... Water Supply: Public system �9 Community system [] Private ❑ Depth ro Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 123 Clay Loam) Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: ilf yes,datt3-------- -----------) No_X New Construction: YesN No ❑ FHA/VA: Yes ❑ N0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weU / iDistance from foundation..._.�_B'+.._.Material_.____ �i.as No. of compartments-.____-_'�----------Size__ �_,14,J� _ vLiquid depth---------- ---------Capacity__-.2-.AQ Disposal Field: Distance from nearest well'.-rm_p------:Distance from foundation.....!kJ_.......Distance to nearest lot line._. . . Number of.lines---_____--J______________________Length of each line.�D_�'_ or'3 .Width of french--______A_ ;f Type of filter material.-. tyc_J�-, Depth of filter material______ ''__-Total length---------`. '� Seepage Pit: Distance to nearest well----1-4, r_'_ -Distance from foundation__lZa----------Distance to nearesf lot Number of pits------,'Z------------Lining material------j��___Size: Diameter.____-3__x---------.Depth:__...�_,;�~'-_'_______-- l Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-._-___-_--___.____._______--------- ❑ Size: Diameter - ---------------------------- --------Depth--•----•------------••--------------------------._._Li Liquid Capacity r q --------------------------•-gals. Privy: Distance from nearest well------------------_------------------------------Distance from nearest building.-____________---___-___._....__..._._.._. ❑ Distance to nearest lot line----------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------ --•---------•----------- -•--•------•-----------•--- t •---------------------------•-•-----------••-------------•-----•------.-..----. -----•------------- -----------------•--•----•--------• ---------------------------------------------.-------------------------------- 7 . --------- • ------ •-- - - - ---- I hereby certify thaf I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State w:.,and..rules and regulations of the Sen Joaquin Local Health District. (Signed)A... - 1 f7t� ��-� L� ...Y�'� ? .1_�L.�._._-•----------------------- Owner'�nd/or Contractor) By .................................... ------- -----•-• ----------------------------------------•-••----------------(Title)--------•- ---------------------------------------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY____:_ _-_-__- '"- DATE..... ..... -- ••------------------ REVIEWED BY -- --------------------•------------------------------••------- DATE. - BUILDINGPERMIT ISSUED------------ --------•---•--•------ ----------------------•-- ;----------------•- -------------- DATE----.----------------------------------------------- Alterations and/or recommendations----- .�____'l........ ,__�- c -- -_ ` y� ,_--------- ---------- --ter ,,!! � ------------- fC,- am! .- -------e -------------.---------------------•------ ----------------------------------------------------- ------------------------------ ----- 1 --------------------------------- ------------- FINAL INSPECTION BY---------- ------ - ------------------------- Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 West.91h Street Stockton,California Lodi,California Manteca,California Tracy,California ' ES 9 REVISED 8.59 2M 5.62 ATLAS -