15534 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------•--- ------------------- ---------------- APPLICATION,nP!, =SANITATION PERMIT Permit No. .. --------------- ----------------------------------------- (Complete in Duplicate) Date Issued ------------------------------------------------------------------ This Permit Expires 1 Year From Date Issued 33 E Application is hereby made to the San Joaquin Local Health District for a permit to construct and install theQ6�Aereide°crbe9. This application is made in compliance with County Ordinance No. 549. IP JOB ADDRESS AND LOCATION.. .......:.:.. - -"' �- II -------- ..... z`4. Owner's Name ------------------------------- U Phone------------ -- ---- Address.---•--•-•••----••-••Q !. . ............................ Contractor's Name --- ---------------k-•---- 1 _ _.. e............................. Installation will serve: Residence qApartment House [ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 9 -- - Number of baths -------- Lot size .... ...............•------------------- Water Supply: Public system ❑ Community system ❑ Private R Depth To Water Table Yb ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam +Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {1f yes,date......--------------I No ❑ New Construction: 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.) � Septic Tank: Dis#ante from nearest well-----..............Distarice from'fo`uridation.-__..........�. -..Materibl.._.-....-_._..._....:"..........._._ ._ -- ❑ No. of compartments------ •---------------Size................................Liquid depth....------. --------------Capacity....................... C) Di F' Id: Distance from nearest well-45"'_-Distance from foundation..lb......•....Distance to nearest lot line.:7........... " • Number of lines_______ ___KI ____ __ Length of each line--- Width of trench___ _ V._...._-______.______... Type of filter 'ateria9 --Depth of filter material___-(_ _________Total langth____� _�D S epage Pit: Distance to nearest we ------------------Distance from foundation--------------------Distance to nearest lot line_------.----_---_ ❑ Number of pits--------_-----------Lining material-----------------------Size: Diameter-----------_----------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ElSize: Diameter-----_----------- --------------- ---Depth----•---------------------------------------------.-Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-------.--_-_--_---..-...-.---.-----.-_- ❑ Distance to nearest lot line--------------------------------------------------••--------------- ---------.-------------------_----------------- e Remodeling and/or repairing (describe):--------------•-------------------`-.".`-`-----------------------------------••------•--•-••----------.....--•---.....--•----•----.......--••----.. ...... f s - .___.____•-----------•--------•---•--------•---•---•-------•-.-•-------------------------------------------•---------•___._..-...__._..---__..._....---------•------------------------•-••-----» ------------.--- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 andiregulations of the San Joaquin Local Health District. 11 (Signed t l �,�` `-="•-•-i!!!& � (Owner and/or Contractor) w tyv_... . , [Title] .... --(Plot plan, showing size of lot, location of system in-'relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ------ -------------------------•--------------------------------------- DATE-j ---------------------------------- REVIEWEDBY-------------- --------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------•------------------------------------------ DATE------------------------------------------------------•----- Alterations and/or recommendations:-----------------------------------------------------------------------------------` - - ---••-•-----••------••----.---------------------------------- .�-. � ,� --.-.-----.-•------•------------------------------- - ------- -•-----•--.--............-----------------------••---- --.--•--- ---- -- -- - --- - --- - --- -- -- --- -- - -----------------------------------•- ------------------------------------- --------------- iFT FINAL INSPECTION BY:Z -1------'-----• '------------------------------------- Date --'----- --�------------------------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 91h Strut Stockton,California Lodl,California Manusca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS = ,r _