14264 - Laserfiche WebLink

Home Browse Search

n FOR OFFICE SE:/ / 7, ------------ - ---. ------ ------ - - - ---- APPLICATION FOR SANITATION PERMIT Permit No. 1 . (Complete in Duplicate) Date Issued ...�..� 7 --------------------------------------------------------- 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 the work herein described. This application is made in compliance with County Ordinance No41,-A 49 `'O 9 � 1 JOB ADDRESS AND LOCATION-_.�.�_.of e----Z,----- -•--------- -•------------------------------------------- Owner's Name................ .. ......---------------------------------------------------------------------------------------•• Phone.................................... Address........................ Q - a-- Contractor's Name............... / / -------- Phone................................... Installation will serve: Residence U30 �kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/-. Number of bedrooms -,4. Number of baths __/... Lot size e .....410.49.11..................... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4011P.`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2_1111ardpan ❑ Previous Application Made: (If yes,date--------------------) No Rgo`*New Construction: Yes ❑ No ®--IFHA/VA: Yes ❑ No E;— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �S--ptir. Tank: Distance from nearest well-----------------Distance from foundation--------------------Material................................................. F^ fY4f No. of compartments--------------------------Size----------------------••--- --Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well------ -.--Distance from foundation...I,Q 1-------Distance to nearest (o` line.s�~/...... e,o H� Number of lines___.____�__-... Length of each Ii�1e_.-_ ...............Width of trench.. "7 / p �__ � ---------------------------- o Type of filter material.f 11(Gl Depth of filter material-----/ �!-----Total length........ D___........................ \ eepage Pit: Distance to nearest well------- --------Distance from foundation..../0........Distance to nearest lot line.+.......... Q ' s� N Number of pits------ ___------------Lining materlal..,/..e0..�-,_Size: Diameter.. '.r3..-......_.Depth_..�.�... .._....._.... 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.......................................... �LL ❑ Distance to nearest lot line----------------------------- ------------------ ......•-••-•••----••-----•-•.....--•--•••-••---••-•-•----••-••••---.....••••••....---------- Remodeling and/or repairing (describe)-------------------1A,W -----------------------------•----------------------•-----------------------..... ------------------------------------------------------------•-----------------------------------------------------------------------------1Z.7.............................................................--------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed)----------------- ------`--- ----- (ego e" Contractor) ( ) BY:..........................................................---------------------- --------- - -- -----=--=---.........Title �k,,� %-----._.......---...-- -------------- (Plot plan, showing size of lot, location of system in rela66n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _� �--- ---- DATE._ _I. APPLICATION ACCEPTED BY...-- .. - - ------ -------------------------------------- -�- ---•'---�---�--�---. -------- REVIEWEDBY------------------------------------- ------------................................................. DATE............................................................ BUILDINGPERMIT ISSUED..............................................................-...................................... DATE............................................ Alterations 7and/or recommendation:... (y/ ... j- -------------------------------------- Y'� .c.d--tib -• ••--•••-•- ---••-•••••••••----•---••-••---•---•---•----------------------•---------------------------------------------------------------------------------------••---••.............................................................. --------------------------------------------------------- ---------------- ------------------------------------------------------------------------------------------------------------------------------------------•------ �-- / --� 2 FINAL INSPECTION BY: � a-- ••... -------------------------------- Date----------.6------ ---- ...7----------.....----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 RM 6-61 ATLAS