17115 - Laserfiche WebLink

Home Browse Search

-SI- vat: -------- --- L'--:'_ APPLICATION FOR SANITATION PERMIT Permit No. ..........:".._..'..... ------------- " " ---------" (Complete in Duplicate) This Permit Ex fires 1 Year From Date Issued / -7 /j,, - -- - -"------ -�- Date Issued ..........,�. ...-�" Application is herebymade 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 LOCATION..... c-........... Owner's Name----- --=---�--'-----��.- - --�"y-L----------------------------------------- -------------------------- - - Phone.. -----•. -•------ Contractor's Name-----�.�.i.;"y "A-------- ---------------------•------•-•----"-------•----------------------.............. - -----. Phone Installation will serve: Residence C& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---i---- Number of bedrooms �".- Number of baths ---(.".. Lot size _.:Z .`."�C Water Supply: Public system C& Community system ❑ Private ❑ Depth To Water Table !i7- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan Previous Application Made: (If yes,date-..--_---_--_.-_-_) No ❑ New Construction: Yes C, No ❑ FHANA: Yes ❑ No 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__h0—4. .Distance from foundation----i-.Cb_...... No, of compartments...___Zr_ Material ---Size._3.-_1�_CV_x- .-t_.Liquid depth.-.--6C ---------Capacity... Disposal Field: Distance from nearest well---Kj:� _Q,_Distance from foundation._..-.I.Q�..."...Distance to nearest lot line_-- ------- Depth �_._ �. Number of lines---------3----------------------Length of each line--------- .__-"•___-"-Width of trench------Z-_4�-""-.-".-"•-__•-•__ Type of filter materials ,_._rt��, ._-pepth of filter material.-_..�.-�`�--------Total length.......lSC�_�_____________________ Seepage Pit: Distance to nearest well_..--_�1� Ak---Distance from foundation_.__1.0--_-_.-.Distance to nearest lot line.....��_•-•- "� ®. Number of pits-.-..Z— g•t r kA Lining matenal�- roc. .Size: Diameter h, Depth ......................... .r Cesspool: Distance from nearest well-----------------Distance from foundation_..-.------_.--.--..Lining material_...... -•--•---••--•-----•-.----- %A 171 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 this application and that the work will be done -- accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ G��"_•�✓ ---•---��_�- ��•'��L��-=-- ---------------•------ ---------------------------------------_--..•_-(Owner and/or Contractor) B 1 wing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (Title)---------------------------- (Plot plan, sho - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----(2 _._. REVIEWED BY------- � a ----------------------------------------------------------- DATE---�-!•- Z -------------------------- --------------- ------------- --------------------------------------------------------- DATE---------------- BUILDING PERMIT ISSUED - -- - _ Aerations and/or recommendations:..- .-- 4--------Ise ;ns 'ks.�1�---- ----�---�•.....U4.- - 0--- .... ..... .} ........... -•-------------------- FINAL INSPECTION BY:------C_. �_S q ----- Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street Stockton,California 124 Sycamore Street Lodi,California 205 West 9th Street Manteca,California ES 9 REVISED 8-59 2M 5-62 ATLAS Tracy,California