14382 - Laserfiche WebLink

Home Browse Search

I" -,FOR OFFICE USE: _.. ------•------------ ------ /,// -----------------------___________________- APPLICATION FOR SANITATION PERMIT Permit No. .........._.Zs ------------ -------- -------- -- ----------------------- (Complete in Duplicate) Date Issued ... --------------------------------------------------------- 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., t This application is madein compliance with County Ordinance No. 549. Pj Lckk ) JOB ADDRESS AND OCATION n --R� --- --`-- 1 -------- ..... ------`-- ........ r . -Owner s dame ARK � Z Phane ---------- Address _ ' Address..... T� ------- 1- ------. •--•---••----------•--•t-�-- -• Contractor's Name_ p QR-�:N...•---• i VA.&j. t7 Phone , Installation will serve: Residence ("Apartment House Ll Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �_____ Number of bedrooms_- Number of baths _2=-Lot size -----'�G_)----__-- - r Water Supply: Public system ❑ Community system [I PrivateDepth r ♦ter Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam Clay Loam-[j Clay ❑ --Adobe❑ Hardpan•❑—.w , Previous Application Made: (If yes,date____________________) No 0-�New Construction: Yes EN, ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPEC IFICATIONS: � � _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Se tic nk: Distance from nearest well___Q_._,Distan a from foundation .. t fvt ■I° < t r t p - --'f�-f-•..Mater♦ I-------��-�-�--��:�� [--- U' id of compartments------- Size_ XVlk __ _-Li uid de th________! _...________�Ca eci Disposal Field: Distance from well ./r __-..'Dja} from #�undation -------- - { tctest lot line NumbeoflnesDistance of cfne � �: chTJ....Wdhoftre r Type of-filter }Depth of filter material___ __ _________ g ,l.z:��.:-_----__-_ •:_Total length � Seepage Pit: Distance to nearest well______________________Distance from foundation------------... ..Distance to nearest lot line-----___•-_-___-_ ❑ Number of pits----------------------Lining material----------------.------Size: Diameter----------- ........ Depth----------._,_._....-----.-.----- Cesspool: Distance-frpm near.est;well________________Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter--------------------------------------Depth--------------- -----------------------------------Liquid Capacity----------------------------gals. Privy: Disi•ance from nearest well________�'------- )_..........-----------------Distance from nearest building------------------------------------------ [] Distance to nearest lot line___________________________________ � t , Remodeling and/or repairing (describe):--- --------' F --...........--•---•--•-•------------------------------------------------=---------•-----------•--••------------------•---•-----------------------------•------------._-------------•------•--•--•------------------------- IF ___________________________________________________ ' 41% I 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 SantJoaquin Local Health District. (signed) `7l r - ------------------------------------------(Owner and/or Contractor) m ----•-. / + ------------------ (Title) f (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can-be placed on reverse side). FOR DEPARTMENT USE ONLY,' APPLICATION ACCEPTED BY------7--jR,_0------- ------------------------------------------------------------- DATE REVIEWED. BY..,.._..- = �----•--•------------------••---------- -------•-------------•--•------•----•-••------............... DATE-------- ................... --------------------------- BUILDING PERMIT .ISSUED--------------------------------------------------------------------------------------- --------------- DATE------------------------------------------------------------- Alterafions and/or recommend♦tions:--------------------------------------------------------------------------------------------------------------------------------------------------------- Cltt i# t�# . -------------------------------------------------------------- - -- ----------------- --- ------------------ .-------------------------------------------------- ......... .-.---------------------------------------------------------- ---------------- .................................. -- ----- --•------- -------j ---- -- -----•--i----------------------------------------•- -----•- ----------- ------------------------------- --------------- FINAL INSPECTION BY:------- - Date------------------ -.`�� 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 Traty,California ES 9 REVISED 8-59 2M 5.62 ATLAS -