15485 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U !� t - -- APPLICATION FOR SANITATION PERMIT Permit No. _.,�.�.....- - ------------------------------------------------------ (Complete in Duplicate) _ 3 Date issued . _---_ _ -_..__._.___ 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 install t6 work harein described. This a li tion is made in co liance with County Ordinance No. 549..n �� PP 1rf ��3 p _L ), 6au1 JOB ADDRESS AND LOCATION. _.F_k - -nr---Il'F- /� p- -- '�� _t r Owner's Name....__ ----------•-------------- Phone... ' J` ----•--•------------------------------- 1 ....lei+ . Address----...................•- -` ----� ---- ------••---------------•------------ Contractor's Name-------.. •-- - Phone----------------------------------- Installation will serve: Residence [K-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l__ Number of bedrooms %?-- Number of baths _ -_ Lot size Llr = Water Supply: Public system ❑ Community system ❑ Private �epth ro Water Table _ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Of yes,date--------------------) No ul__`N w Construction: Yes gT No ❑ FHA/VA: Yes ❑ No P—r E TYPE OF INSTALLATION AND SPECIFICATIONS: . � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ._:__�/-__e�< ---- Septic Tank: Distance from nearest well----- _t Distan e'fpm foundation___ No. of compartments____--- -- -- --- a_""_Liquid depth_____-� _ _-_____ ..Capacity_..ef� ---•• ®/r Size.. nearest well-_ _ Distance from fou`ndation. Q---------Distance to nearest lot�ine__ ...... Disposal Field: Distance.from �ro i ,, ...-- '------------ Len thi of each line_-_-- --�---- -------------Width of trench.___r2-..---- --------- Number,of lines___.-__ �"�----- r g__ pf� - 1 Type of filter mate�ial._� QDTepth,of filter material•__ZLi---_____.___Total length____. :__ _ r _;r ----'------.Distance from foundation....................Distance to nearest lot line____._...___----- Seepage'Pit: Distance to nearest well_[] Number of ------ material------------------------Size: Diameter-------------- •-------,Depth-----------------•------------ i Cesspool: Distance from nearest well_________________Distance from foundation---.----------------Lining material-------.--------------------------- ._ EluSize: Diameter--•-------------------:---------------Depth-----------------k "-----------------------------Liquid Capacity---------------------------- .. Privy: Distance from nearest well-----------------------------------------.-------Qistance from nearest building-------------------------•--------------- ❑ Distance to nearest lot line-------------------------- --------------------------------- -------- - -----"- - Remodeling and/or repairing (describe)-------------� t ••---------------•------ I ---- -=-----------------•----------------•-----•--------------•-------------------•-------- Y.eta. _______________________________________________________________________________________________________________________________________________ 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 les and regulations of the San Joaquin Local Health District. (Signed).. ------ ---- --------"---- ' ----------------------------Owner and/or Contractor) ie, I (Plot plan, showing size of lot, location of system in re ' n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- •---- ------------ ff} f DATE------- ----------- ----------------------------- REVIEWEDBY.----------------------- ..-------- DATE------------------------------------------------------------ BUILDING.PERMIT ISSUED------------_------------- - --- DATE------------------ ------------------------------------------ Alterations and/or recommendations:----------------------------------------------------- -._..-----....._ ...------...------•-----...-----.._..-.---•--------••------------------ ---------------•--------------------•..............................................•----------- ----------••---------•--------•- ------- ---------------------------------- --------------- ---• ------------------------------- F Date------ --------------------- FINAL INSPECTION BY:.._.-_ ._ _...._ . SAN JOAQUIN'LO HEALTH DttISTRICT� tj .J , l 5� \\ \o".1 f�'1 130 South Arn#rican Street 300 West Oak Street ti 144 Sycamore Streel� 205 West 9th Strati Stockton,California ll Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS