15524 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- --------------------------------_______--------- APPLICATION FOR SANITATION PERMIT Permit No. ..l��. --------------------------------------------------------- (Complete in Duplicate) Date Issued ....................... ----------------------------------------------------• --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health.District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION----) -. _. .......................................... Owner's Name....._..___ .t_.......S.- - --s.�, . Phone....�_C7.... �.�4�.�. Address._ = - 1-�---•------------------------ - ---•----•--•--•-----------•- Contractor's Name..... G-•--- .................................................................................. Phone................................... Installation will serve: Residence jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __1..... Number of bedrooms ---! Number of baths ...I.... Lot size .....A?Q.X...t'Ak........................ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M-`�iardpan ❑ Previous Application Made: (If yes,date____________________) No [ )ew Construction: Yes [jD----Woo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Sp- t* Tank: Distance from nearest well----!��..Distant from foundation.......t P:..__..Material__ No. of compartments______-_--!;L-__..........Size..... ---3-K251. depth-_______I--------------Capacity....90 .9.. Disposal,Field: Distance from nearest well---- --..Distance from foundation.--_ 2.....Distance to nearest lot line.......�5. .�. [i]� Number of lines.______.._/_______________________Length of each line---------- 1 .. --._.Width of trench....... of filter material.,-----Depth of filter material-------L-1----------Total length............ d--•-•----••..._--•••-- Seepage it: Distance to nearest well________—�._.Distance from f undation....J`0__ to nearest lot line...... Number of pits---------- ----------Lining material--s� --.Size: Diameter---._ -��.._.Depth._.......:Z� �----•_-•--• Cesspool: Distance from nearest well.................Distance from foundation_-_.________._.-_-_.Lining material........................... .......... ❑ 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) -------- ---------------------------------------------------------------------•------•--........................................................ v ........................................................•.............•....................................................................................................................................................... .................................... ---------•------•-••-•...-•-•--•••---•••--••••---•--------••••••--•-•--•---•-•••-••••--•---••--•••••••--••----•••-------•----••......•--•----•----•-••-••---............................ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,)SIalaws, and rules and regulations of the San Joaquin Local Health District. (Si reed . = --------•----------------- �9 ) (Owner and/or Contractor) By:.. .................................................. ..............................................................................(Title)-----------------•----------------------._..-------------------- (Plot 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-- A `. ------------------------------------------- DATE.... ....."'- `- REVIEWEDBY....................................... - ------------------------------------ --------------------------------------------- DATE-----------••---------------------••......-•-•----••---•--- BUILDING PERMIT ISSUED................ : - - -- °................. DATE.-,,,-,;,- ------• - � s .....Alterations and/or ndations. _t _..... -- �aG.�s-� ........ FINALINSPECTION BY----------------------------------------------------------------- Date.............................................................t#.............. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 8-59 2M 6'61 ATLAS