14710 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -- ---- ------------------------- ....................... -_-. . ---------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...1. ._. . (Complete in DupReate) --------------=------------------------------------------ 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 Flo. 549. , L JOB ADDRESS AND LOCATION.............. O 3.I . ....... ,, . ............................................................... Owner's Name .. ---•-:--•---------••---------------------•-----------................ Phone.................................... Address--•--•--•.............1 a__J./__. ti.. -• •------------___--------------_--__---_------_---_------------•-----___----___--_----•-----•--------____-___--- Contractor's Name..------•--•---___ ...................... ••----...... Phone........................ Installation will serve: Residence`' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./. Number of bedrooms ./.- }umber of baths Z.. Lot size .............6:q._X........2.a........... Water Supply: Public system Iff Community system ❑ `Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (] Clay Loam ❑ Clay m Adobe{ Hardpan[] Previous Application Made: (If yes,date--------------------) No -. New Construction: Yes, J No [:] FHA/VA: Yes ❑ Noj TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.................Distance from foundation....................Material............. -----_--.......... .................. ❑ No. of compartments-----------------------y Size.................................Liquid depth..........................Capacity....................... Disposal Field: Distance from nearest^:well___ o _._Distance from foundation..... Q.~._-.Distance to nearest lot line...:.�... 4! '' Number of lines................(_-...............Length of each line.........3,tt'.--._.� ,..Width of trench.........a�............-...... Type of filter material....__�rtel�.Depth of filter material..__.__e.8.._.._.._Total length............11?:_..................... (4 Seepage-Pit: Distance to nearest well......... ____Distance fr fo ndation..__..a ._._.Dis>nce to nearest lot line.__>...._... � Number of pits...... ---:----Lining material....A ---Size: Diameter.A1.... Y!�&epth.....-r .................. Cesspool: Distance from nearest well.................Distance from foundation....................Lining material............... .................... ❑ Size: Diameter------------- --------------------Depth----------------------------------------------------Liquid Capacity............................gals. 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+his application and that+I wvork wilt be done im4ccordence with-San Joaquin County ordinances, Stere laws, and rules and regulations of the San Joaquin Local Health District. (Sinned).............•-----�Alot-io . -%ire ------- ------ /--------...---------------------•-------------...-�r and/or Contractor) By:..... -- ,/ `2... Ay--..........(Title)-------------------------- -= (Plot`plan, showi size oion systetion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------ DATE...... ---------- REVIEWEDBY............................. ------ .• ----------------------------- .............................................. DATE........................................................... BUILDING PERMIT ISSUED..................... .......................................-...................................... DATE.............................. •------ Alterations and/or recommendations:...._ ---------------------I. -------.._........ .... "_ .......... =- =...........-V-----•---•-----••-----•----•-_..... .....................•-•--. .. ------------ _......••---•--------------•--------------------••-----•-------------------------•----------------...----------•----•----------••--•--•--•--•-------•--•--........•-••••-----•-•------•-••-----=•--------------•--•--------•-- --------•-•---------------•------------------------------...-----------------...---------------•------------...---------------------------------------------------------------------------------•----•-------•-----•...._..... IFINAL INSPECTION BY-------------- .................................................. Date................................................................................ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street. Stockton,California Lodi,California Manteca,California Tracy,California 92 9 REVISED 8.69 pM 8'61 ATLAS �♦