14613 (2) - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------- -- --- - - ----------- • APPLICATION FOR SANITATION PERMIT Permit No. .............. --- r ;,f ------------------ _-__sf_*-'' (Complete in Duplicate) Date Issued . -�.�—� -- --I ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Z' stall the work herein described. This application is made in compliance with County Ordinance No. 549. �i� y �Y t?c j, _ � r e JOB ADDRESS AND LOCATION-,4 �`--.e0e:.__.d, /'r' Owner's Name.....• -!- N Phone.. Address_.... �ji�1 1..�*. •--•-••. + t=---�- .......... Y ... Q , t•---•---------------------•••--•••--. Phone........--••••..•_... Contractor's Name_-•-------,li.�Qll/-'----��.rs.�.•r---•-•---------------•-•- ........-•---• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel'`o Other ❑ ✓gip Number of living units: -./_. Number of bedrooms,.__ Number of baths A.. Lot size �/��` -------------------------•------•----••- Water Supply: Public system ❑ Community system ❑ Private [JR"Oo'bepth To Water Table Wft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam [I Clay E] Adobe�ardpan ❑� Previous Application Made: (If yes,date--------------------) No L New Construction: Yes U?No ❑ FHA/VA: Yes [lRo" No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i 1, Septic Tank: Distance from nearest well -------------- .qe _Distance rom foundatign----ZQ.........Material...L°.4f�-•... •-- No. of compartments__.__-. --SizeO. � QLiquid depth__.../_____________Capacity Is Disposal Field: Distance from nearest well__ ___._Distance from foundati n...lv......-._.Distance to nearest lo� linNumber of lines___._._ .__ ___-_.-_-_ ength of each line__ Width of trench.,r2__.._ J________________Type of filter material-_ -Q epth of filter material____,� _______._Total length___.,/��_______________---n � /Seepage Pit: Distance to nearest ell.__.�t�Q____-_Distance fr fou dation__-,.t2-_•._...Dt ryce to nearest lot lin.d0•------e Number of pits---- -----------Lining material_.__ L�-Size: Diameter_ Depth�ol------------------Cesspool: Distance from nearest well_________________Distance from foundation..-__---._--__-__-..Lining material•--.-.--_----.-___---------_---__❑ Size: Diameter--------------------------------------Depth----•-------------- •---------------•-------Liquid Capacity----••---•-----------••----g Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building.____-.--_--•__---_--_-•---_--__-------_-. ❑ Distance to nearest lot line------ ------------------------- ----------- -------------- ------ -- Remodeling and/or repairing (describe)---------------�if/(/ �_ --------•---------------•-••--------------••----•------- --------------•-•---•--••--•--•----------•-•..................-----------------------•-------------------•------------------------ ----•---•--------•---------------------------------- -------------------------------•---------------------------------------------------------------------------------------•--------------••---------••---.----- 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 r s and regulati ns of the San Joaquin Local Health District. • -~ - /or Contractor (Signed)................... G i ,p ------------ Title By:.........-............................................... --------- -- ( ) i (Plot plan, shovXng size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY V t 1 FF APPLICATION ACCEPTED BY-------. - ��.. DATE REVIEWEDBY--------------------------------------------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED------•--•- -----------•----------•-------••-----•--5�.....-------------------------------------- DATE. ; Alterations and/or recommendations:... " 9 " -------( ------------ W.:=.-----. ------------------- ------------ -------e----•-61�....................................... --------•- -------•----------•--------------------•---------------.....--------------------------------------------------------•--------------------------------•---•-•. ......................................... ------------------------------------------------------------------ ---------------------------------------------------•- --------------------------------- -------------------------------- ---------- ------------ -----------------------------------------------------•------------- FINAL INSPECTION BY:.----- .-C... c ------------------------------ 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 8.59 2M 5-62 ATLAS