15456 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ../......r.•_-�� -------------------- (Complete in Duplicate) / I "_> ------------------- 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. 50. 4 JOB ADDRESS AND LOCATION...Ws ___-_-y�� Owner's Name__....+�Q,UO.A-i 5 7 -----------------------------•- ----------- Phone._.G 1a.1...' Address------1.61-_( ^v1 Contractor's Name � -!_.fL.l �tL _t - -------------------------- � --��--4-4.7._9 Installation will serve: Residence ❑ Apartment Hous<�:"C,o r�mercial (� �Ttailer Court ❑ Motel [I Other ® C R M Number of living units: ..__.___ Number of bedrooms -__-_ Number-AW"fs Lot size -------- ize . Water Supply: Public system E] Community system ❑ Private (g Depth to Water Tablef#. Character of soil to a depth of 3 feet: Sand ❑ Gravel-0 '"Sandy Loam ❑ �40ay Loam ❑ Clay❑Adobe® Hardpan ❑ ,Previous Application Made: (If yes,date__..___.._.__.___.] Norte;-1 New`Construction: Yes No ❑ FHA/VA: 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 wellt;? Distance from foundation...._C _.....___.Materia�_ - - No. of compartments___ � f - Liquid depth_-A_'-��.t- --------._Capacit-y-__--•��---.-.-.-.-.-.-.--:--.--.c�-.-.6-.- I Disposal Field: Distance from nearest wellDistance foundation----lQ----------Distance to nearest lot line...Number of lines.... -- -----.of each Ine ---0- Width of trench----Z Type of filter material:!-r +rLC.'�-.,Depth of filter material-------(.____.____Total length_____-.?Q.t.................... Seepage Pit: Distance to nearest well-----------------------Distance from foundation_--___-__°---....--.Distance to nearest lot line__--.-_____-_---_ ❑ Number of pits----•-----------------Lining material -----------------size: Diameter....---------------_--,Depth--------.- --•-•- Cesspool:e Distance from nearest well-----------------Distance from foundation-------------------- material._,-" --------•- ❑ -Size: Diameter--------------------------------- ----Depth--- ---------------------- --..Liquid Capacity � i ❑ t _ "Privy: Distance,from nearest well-------------------------- from nearest building____--_ __..._.W._F __...___ -----.Distance to nearest lot line_________________.____•____-- 4 t modeling and/or repairing (des ribel:--- -1c1- - ---- -- -- - -yy�•___., _ emo 44 _ _ --�-•5 - •---'GL.d�� 41et.-�.-----�--4�✓�5.�'--•--i�i.�.e�. I `..--8�••.- 5�-4-•-•� -- -- --------------- ------------------------------------------------------------------------------------------------------------------ ' = ------------------••-----------------------------------------------------'---------------- !'.:- I hereby c ify that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. ' I (Signed) = --- ------------•---- -------------------- ----- (Owner, and/or Contractor) BY: ----•----------------------------------------- t--------.k.--- -- {Title] -{ -- - --------------- (Plot plan, showing size of lot, location of system in"relation t wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY------ .-s_._ y ' = DATEZ_ 1 _ --..,.�. .. -�--- ---- - _.. REVIEWED BY-------------", - -r' - ---------------- -------------------------------------------------••-------------------------- DATE----------------...--• BUILDING PERMIT ISSUED---------------------------------------------------------------- A •- ----------....__ DATE----•---- ----- Alterations and/or recommend'ations------------------------------- ------------------------------------------------------------------------------ ----------•----------------------------------•------------------------------•---------------••------------------...,---------------••---------- ...---------------------------------------------- --------------------------•-----------•-•----------------------------------------------------------------------------•---•---•--------------•-- ----------------------------------------------------------- FINAL INSPECTION BY:....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Str6et Stockton,California Locil,California Manteca,California Tracy,Californlo ES 9 REVISED 9.59 2M 8.61 ATLAS sem.. l