14734 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �» .......................------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ..(..`�.7.3.`_ ----------------- --•--- ------------------------------- (Complete in Duplicate) ' l --------------------- 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND ATIO ....___._._ ` --�� - ----•--- -------------------------------------------•-•----•.......................................................................... Owner's Name... -- . . ...... ------ -- ------------- ---------- --------------------------------- Phone, k..:.-s.--;:P i Address---------- ,gyp- . Contractor's Name..._. 4 /' �-... Phone _.. m7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail r ❑ Motel ❑ Other Wz�. Number of living units: ____.__- N mber of bedrooms ........ Number of baths _ .____ of ............................................. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-5_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2'-Hardpan ❑ i Previous Application Made: (if yes,date----- --------------) No ❑ New Construction: Yes 2`1N-o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifuubliic��s��ewer is available within 200 feet.) ' Septic T k: Distance from nearest welltF.Orw'__Distance fromrfoundatAsn.-10-i----..Material 1 e ��--•��►► .. � ------------ --- No. of comportmems------- >-----------Size----s,J..GP....___ 4_Liquid depth___..__-..7��2_----_Capacity.._Disposal •eld: Distance from nearest ell !'Distance from foundation_c2D._......._.Distance to nearest lot line.___-_-- Number of lines--------- ----- ___Length of each line_..©-`_____ ________Width of french.__ c�. _._____ Type of filter material. ��-,,�� ...Depth of filter material____.IS----------- length-------------------�d !_..__-: E Seepage Distance to nearest w ILL ?'�.___Distanc r m. f ndation_� ---------Distance to nearest lot line..-�.�___-_ Number of pits---._____________Lining material. __.Size: Diameter__33.__...___.Depth____. ............... Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material---------------------------_-______•_ ❑ Size: Diameter--------------------------- ------Depth-----------------•-•- --------------------------.._Li Liquid Capacity - 9 -•---•-•-------•--...-------Sols. �4 Privy: Distance from nearest well-_________________________________ ___________Distance from nearest building--------------...._.._ ❑ Distance to nearest lot line Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------- ........ ............. -----------------------------------------------------------`------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------•--------------------•----- ---------------------------------------------------------------------------------- --------------------•--•--------•-----------•--------•-----•--------------------------- ...._ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances,°S a aws, and ules and egulations of the San Joaquin Local Health District. (Signed)--- ._... --------------------------------------------- towner and/or Contractor) I By ------------------------- ----- ---• -- ------------------------------------------------------(Title)-------------------------------------------- (Plot plan. showing size f lot, location of sys+ in relation to wells, buildings, etc., can 6e placed on reverse side): FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED B 'X_ - ------------ --== DATE _ ._ REVIEWED iiY.-.. ------------------------• --------- e s ...-•----------------- DATE.-_.------- ---------------- BUILDING PERMIT ISSUED---•--...---•-------------------------------------------------_---------------------- ?------.-._. DATE---------- ----- { Aa tons nd/ re 'commendations -•------ _ t ------------------•---•---•------•-••---------------------•---- ----•-------- 1-1.1-----------------------------------------•-------------------•------------- -----•--------------- FINAL INSPECTION BY:----- -------------------------- -• -- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 304 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 0 REVISED 8.69 2M 5-61 ATLAS