14372 - Laserfiche WebLink

Home Browse Search

FOR FFICE.0 E: -2 L. :..... ::..:.. � /(�,- ?APPLICATION FOR SANITATION PERMIT Permit No. .�..��..�.Z ------------------------ (Complete in Duplicate) 10// --------14 "---`-- -------------- ---------- 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 witch County Ordinance No. 549. JOB ADDRESS AND LOCATION.. -ft--- __C� fit. Owner's Name.:..__J_ie .. -...1; !!11 !------- •-------------------------------------------------------------------------------------- Phone.................................... Contractor's Name «.................;.. .......-•-•-•---•--•-•-----•••------•--...•-••-------•---------•••-••---•-----•....... Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [ Iviotel ❑ Other ❑ Number of living units: ." Number of bedrooms .A.'- Number of baths k' Lot size . aCII........' ....................••••.... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table WP. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej—Rardpan ❑ Previous Application Made: (If yes,date___---------------__) No2T`� New Construction: Yes [[5""'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tk: Distance from nearest well-----------------Distance from foundation....................Material................................................. No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity....................... Disp al Fi *- Distance from nearest well__02%4r7'%C.-Distance from foundation.../©............. Distance to nearest lot line-if.......... Number of lines..------_R.� �----------------------Length of each line----- �..-/-- -��.__...Width of +ranch..-----• - -- -------------- a Type of filter material.-.-Te-4t--.-_..Depth of filter material-.-_- length............... d-'................ I See a Distance to nearest well_:'?L�t�l�_.._._.Distance m foundation....1A...........Distance to nearest lotWt p 9 . ��CC$$ r'�� Number of pits........'-----------Lining material--.-1-�.C4..Size: Diameter...+,r...........Depth.--.._...4.9'........... 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------------------------ *...-------------- [I .._.❑ Distance to nearest lot line--------------------------------------------------------------------•---- Remodeling and/or repairing (describe) -----------------------------------------------------------•- -------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------•--------------------------------------------------- I hereby certify that I have prepared this pli ation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati s the S n Joaquin Local Health District. (Signed) -- ----------- --------------------------------------------------------------------------------(Owner and/or Contractor) BY: -------- - --------- ---------------------------------------------(rititle)------------------------------------ (Plot plan, showing size of lot, Iota ton of system in lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...,-. ------------------------------------------------ DATE...6--'./ P9 REVIEWED BY ... •---- DATE------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------...................................... DATE / Alterations an/d`/or recommendation :------- -- ....................... - j J 1 C ....................••-----...-•-••--•-------•- -----------------------------------•------------••-------------------------------•----............................................................ --------------------- ----------------------------•-------•----------------------------------••--•------------•--•------••------•-••---- ------------------------------------------------------......... FINAL INSPECTION BY:._. Z __,h + -= / _ f - 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 ES 9 REVISED B-59 2M 5-61 ATLAS