15465 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------- --------------------------------------- ------------------------ --------------- -------------- ---------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- - --------------- - - -- (Complete in Duplicate) Date Issued --------------- --- ._- ----------------- __. This Permit Ex fres 1 Year From 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. 549. JOB ADDRESS AND L CATION.... ..- ---_-- ' Lp - 'Cp----•-•- .... .... --------- Owner's ----------------- Phone------------. ----------•----------- N � �+r,�e`.•':. � r ----------------------------•----------------..-----------------------------------------------------•- Address.-•------------- ---------------- ------•----------- ---- Contractor's Name..--.. ajar �- --- Phone------------------ ---------------- Installation will serve: Residence Apartment House Commercial Trailer Court [3 Motel ❑ Other El Number of living units: .-..-- Number of bedrooms _-,3-.. Number of baths .;' Lot size ...... OCA................t, ........... '-."--•••-----••••- Water Supply: Public system ❑ Community system ❑ Private ] Depth To Water Table Y-p. ft. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam® Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (1f yes,date--------------------) No o New Construction: Yes JENo [-] FHA/VA: Yes F] No [I TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well__�6r----_-Distan from foundation--- ---------- -.Material------..--------_.._---..............---- p / { No. of compartments Size- x-----f - -----Liquid depth------ --------------Capauty- ------------------ x 'R Disp�4osal Field: Distance from nearest well..os�_------Distance from foundation`-/p-----------Distance to nearest lot line_........... Number of lines-----+)------------------------- Length-of each line_.-d`------_._------...Width of trench.AY- ------------------------ Type ---..------- ----- - Type of filter materia- ;_Depth of filter material.-,/?�------__--.Total length_ -- -`------------------------- 1474 -. -------•.--------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line--.---_-..-.--.-. ❑ Number of pits----------------------Lining material--------!� ------.Size: Diameter----------.-------------Depth--------------------------------- Cesspool: --------------------- -Cesspool: Distance from nearest well---------------- from foundation--------------.__-.Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------- -----------------------ii'--------.-Liquid Capacity----------------------------gals. ' f"Disfancs from nearest buildin Privy: Distance from nearest well- :- �,-_:_-� 9 ❑ Distance to nearest lot line---------------------------------- ' ---•---------------------------------- Remodeling and/or repairing (describe) �K�*�, -----------••--�-----------•---------_--------------••------- r.. ' --- ------ ----• -----.-;..-..----------•---------------•---•-----....---------------------------------------------------•-----•------------------------ -_-•:;---- -----------•------------------------------------------------ I hereby certify that I have prepared this application and that the work will beldone in accordance with San Joaquin County ordinances, State aws, and rules and re yrlations.of the San Joaquin Local Health District. (Signed) *�' ---------------------------------------------------------------(Owner and/or Contractor) --------------- Title -------------------- -(Piot plan, showing size of lot, location of system in relation to wells, buildings, etc.; can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- --- -------- ------------------------------------------------------ DATE_ -------------------------------------------- - - - REVIEWEDBY---------------------------------- - ------ -------------. DATE--------- ------ --------------------------------------•-- BUILDING PERMIT ISSUED---------------------------------------- DATE-------------------_- --------------------- ------------ -- Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------•---•-----------.....--------•---------------.....------•--- --------------------------------• ---------•---------------------•------------•------------------ ------•---------------------------------------- ------•------•-----------•--------- ------- --- FINAL INSPECTION 8Y �'zlJr -.. Date _.� 6 ----------------•- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wesf'91h Street Stockton,California Lodi,California ' y Montece,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS 'a. r