14620 - Laserfiche WebLink

Home Browse Search

rvtcvrrlL.0 UN:: ka 1/0 - y0- Z-0- o """"----------•-------------------- ------------------- fAPPLICATION FOR SANITATION PERMIT Permit No. ---- ------------------'------------ ----------------- (Complete in Duplicate) - ----------------- ----------------------------- This Permit I~x ires.l Year From Date-Issued Date Issued .... Y a ' b ..r Y', " 3 �. f �.�i r,...-� . Y.-.. , Application,�is,hereby.,made„.to�,the.Sen..Joaquin,Locaf Health Disfiric#for cf`perrr►it fo construct end install the work�herein�desrrbed. This application is ma0e..in.compliance with County Ordinance No. 549, fv JOB ADDRESS AND LOCATION_ __A ` ._ I,V+f�'� Owner's Name. = 0- '------------t�� r�_/. - ----------” Phone.................................... Address_- .. ••�.`� --4--a r�Ir "---- "-• Contractor's Name------- _ -- ----- - ------------------ J - ----------Phone................................... Installation will serve: Residence [T Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: -•1___ Number of bedroom__ Number of baths -Lot size .__._ I} �....,�. - ----- ------------------- Water Supply: Public system ❑ Community system„❑ Priva;te �pepth ro Water Table®. ft. Character of soil to a depth of 3 feet: Sand Gr elt� Sam ❑ �V�� ySa�yyLoam E] Clay Loam❑ ,Clay [I Adobe❑ Hardpan Previous Application Mbde: (If yes,date----------------_..) No 0 New. Construction: 'Yes 6'_O'�No_❑ FNA/VA: Yes ❑ No tA_ -TYPE OF INSTALLATION AND. SPECIFICATIONS: . _ (No septic tank dor cesspool permitted if public sewer is available within 200 feet.} Q T F Septic T k: No{of compartments Disfian41D undafton----- ------------,.M er+ L. ?l _5- _._�'p P '---------•-Size- •- �iquid depth-,-- o . ----Cap acit �� ':1 - . P Len th of each line ion Distance to nearest lot line _... .� �. F Disposal Field: Distance from nearest ell__ __ __ -� Number of lines___.___ g �_ •�L�3."71a.'Z�? ._._Distance from foundat+ ----- Width of trench.___ �.�-�-_ , f---------- •-- Type of filter matenal__._.&2�.�.---Depth of filter material------Z�-'___._Total length.......,1��---�_ Seepage Pit: Distance to nearest well----------------------Distance from found tion_______ Distance to nearest lot line_________________ Number of Cesspool: Distance from snearest well_--Linin---.mDistance from found I��Diameter____..__________..,_--.Depth________________•,-------_•__--_- P 9 atian--- ------------- Lining material----------_-------- El Size: Diameter--------------------------- --------- Depth---------------------- "Ji------------------_Liquid Capacity ----------------------------gals. Privy: Distance from nearest well__.------ ____________________________________Disance from nearest building. ❑ Distance to nearest lot line_...____.__ 8i - Remodeling and/or repairing: (describe):------------------------------------------•----------_ ---- t - ----•-----•-----••--••----•- f -----------------•`•'-------•--------------------------------------•------•-------•------------- _______________________________________________________........._________________•_____-_.______--______.-..___________..---.______.______...------------------- .---------------------------- ._____--_____--.___._____._ herebycertify that I~ha've `` y prepared this application and that the work ill b"e done in accordance with San Joaquin Coun ordinances, State I ws, and riles lid egulations o e San Joaquin Local Health`District. (signed).... .-� _______________________(Owner and/or Contract t If BY- � zi ---------------- = -= Fitfe} _ -``; =- -_._: Contractor) (Plot plan, showing size of lot, location of system in relation 0 walls, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY DATA APPLICATION ACCEPTED BY---- " , �- E_ `'""' . ... VIEWED BY--------------------I - ---------- ---------------•-----------------------------------.,.-• ----------.. DATE---------•--•-----• ------------------- ------------------------- BUILDING _._.___..____. ' 8UlLDING PERMIT ISSUED- ----------------------•-------...------ •=---------------� DATE.......•------------ Alterations �-----`---------••- and/or recommendations:-------------- -------------------------------------------------t--------,.-.----------- ------- -------------------------- -------•------•---------------•-- ----- i •--..-------•-•------ ------------------------------------------------------------------ -------- -------•--- FINAL INSPECTION - --------- Date--------• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Soto 300 West Oak Srreet 124 Sycamora Street 205 West 9th Street Stockton,California Lodi,California Marttaca,California Tracy,California ES 9 REVISED S-55 2M 5-62 ATLAS Y: •