14591 - Laserfiche WebLink

Home Browse Search

FOR OF FICE}JSE fl ---------------- _.._. FOR SANITATION PERMIT Permit No. ..... 1.. ..6.. --------------------------------------------------------- ,\�PLICATION (Complete in Duplicate)ae Date ------------------------------------------------------------ This Permit Expires 1 Year From Date Issued DIssued �.. :.....:...... 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 C ty rdinance No. 549. JOB ADDRESS AND O TIO .---•--. R--�- -- .............. u � --------•-•--------•--------••-------------- Owner's Name........... Address--------••-........ _ . ..................... = -------•-------------------------------------•-------------------------------• ----- Contractor's Name........... -------------------------------------•--------------t,....----•-----••--------------•......_.......-., Phone_,__i --------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ........ Number of bedrooms __a. Number of baths .../-- Lot size ...___�__�..�f��......................... 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❑ Hardpan ❑ Previous Application Made: (If yes,datee27!&ix___) No ❑ 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 well Distance!from foundation...../_/........Material_ _ �.. ......... Off No. of compartments________........Size__ __ _j,.__Liquid depth_......�.............Capacity.T,40. Disposal Field: Distance from nearest well,.-----._Distance from foundation... ......Distance to nearest lot line.......�.11 Number of lines________________ Length of each line....... �?.!.__._...W1dth of trench.__._,2 ....................f Type of filter material._./.�_-Depth of filter material---1 ---------Total length.........�Q-----------------•----••. Seepage Pit: Distance to nearest well__. _.Distance from f undation_--4--4-----_..Distance to nearest lot line ........... Number of pits......./---_---------Lining material4 -Size: Diameter___.. ... 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........................................... ❑ Distance to nearest lot line.............................................................................................................................................. Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------•------------------- •............ .....................................-----------------•-------••--••--------------•-••-----•----------•----• ---------------------------------------•---- .............-.............................................. ------•-------------•-----------------•-•••--•-•---------------•------•----•-...--------------------•-•-----•---••-----------•---•-----•----•-----------•--••-------•........................................................ -----------------------------------------------------------------------------------------------------------------------------------------------------------•-----------•----•------------•---------•-------•••......--------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , a rules endregulati of tha-San oaquin Local Health District. (Signed)--------- ----•-... . - - -----------------------------------------------------------------•-----(Owner and/or Contractor) By:....................................................................................................................................(riitle)................................................................. (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 ' r ,,alp"---- ----------------------------------- DATE-------- ----- .'......... �i- REVIEWEDBY------------------------------------------- -•------------------------------------------------------------------------------ DATE........................................................... PERMITISSUED.....................V2--------------------------------------------------------------------------- DATE............................................................. Alterations and/or recommendations -...:_ - .r. a ---------------- c.... �J{ +� ---- ---. --- ---- --- FINAL -FINAL INSPECTION BY:.------ 2' `� ate 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 5-59 RM 5-61 ATLAS