15416 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: a, 7713 ..... ......... l' __ _ APPLICATION FOR SANITATION PERMIT Permit No. ----- ------ -------- ------------ ----------------- (Complete in Duplicate) -------------------------------------------_--_.___.__- This Permit Expires 1 Year From Date Issued Date Issued `4G-3yo � a9 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. B AID rr rr 5 l b ,� '► JOB ADDR LOCATION_ __ _ _ ---•. Owner's Nam ---- - - ---- --=- ---- - - -- - -_-C��'--'------------------------ Phone- --- - -- Address. ` �..----- . Q ! 1 E� - ` ? Phone' ----- Contractor's Name. --- Installation will serve: Residen;-1 Apar4hlent House ❑ ommercial ❑ Trailer Cou ❑ Mo#el ❑ Other ❑ ry � � Number of living units: ��mmunity mbar of bedroom.._ ._ Number of baths .�- Lot size Cf' ?-.___ �--••----------•-- : Publics stems stet ❑ vtivate ❑ Depth To Water Table _•-_____ ft. Weter Supp y y Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ y E] Adobe❑ Hardpan C]licati Previous Application Made: (if yes,d ) No �ew Construction. Yes No [3FHA/VA: $� YesNo ❑ q PPate-------------------- � . TYPE OF INSTALLATION AND SPECIFICATIONS: - ` `�(No'septic terik"or cesspool'permitted if public•sewer is available within 200 feet.) (� ; Septic Tank: Distance from nearest well_�_r Distance from foundation,�.O-�-----..Material___.____.______- -`............... ! / No. of compartments_.. ------------Size- er_ ---Liquid depth-_ �-------Capacity.c ? •- ®! Disposal Field: Distance from nearest well_ XA_.)_-Distan a ro`3m foundation.i./_-Q--___..Distance to nearest lot line---------- V Number of lines__,_______�_�___,________ . Length of each line. ,h------.---��--Width of trench.._.- _____�.._______ Type of filter materiaeatz :.o, Depth of filter material_--- ..Total length........... ��.2' _- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----............. ❑ Number of pits---- Lining material-----------------------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-- ----------------------------------------------------------------------------------------------------- ----------------------------------- 1 Remodelingand/or repairing [describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ I ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------•-------•--------------°----------------------•--= ----------------------------------------------.------------------------•-•-----------•--- I hereby certify that I hav prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta law d es and regulations of the San JoaquinLocal�H alth trict. (signed)--�-- --- �--�'--- ---- �---- -��-'--�------- �----. Contra By---------------------- _ {Title)--------------- --_.----------- ------------ ------ --.-------- re plan, showing size of lot, location of system in relatio o wow, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------� _ _- DATE..__ _Z4..7 6_2 _-------------- REVIEWEDBY----- --------------------------------------- ---- ------------------------------------------------- ---------------------- DATE------.- ------ ---------..--------------------------------- BUILDINGPERMIT ISSUED------------_ -------------------------------------------------------------------------------------- DATE------------------ •-----••-------------------------•--•----- Alterations and/or recornmend'ations-------- -------------------------------------------------..--------------------------._.-----------------------------------I----------------- -•-••---------------------------------------------------------------------- ----------------------------------------------------------•------------------------•--•-------------- ------------------------------ -- - -- --------------- ----- --- ------ ---------------------------------.-..------....----------•---------------------------------------------- --------------------------------- FINAL INSPEC ----- - - - - --- --------•-------- Date_.. ...Z ..n._zl.--=-- --- --------------------------- 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 2M 9-62 ATLAS