15201 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - --------------------- c ---? .31�- - 1--- APPLICATION FOR SANITATION,PERMIT Permit No. .__f --------------------- This Permit ECx mese]e in Ye auFro Date ---------------------- Date Issued r ---- ------�--- Issued ase Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta Lt(- --z7 ll the work herein described. This application is made in compliance with County Ordinance No. 549. AV- CATION_ _... �� iv ----- ---------- ------ JOB ADDRESSAN- O .................................................... _ C Owner's Name ........... Address KJO.Lue_ — ------ ------------ Phone---- ....-•••---------•-----------•--•--• -•-•--••-•-•• -------------------------------------------------------- ---•�-�-•------'-•C--�-•---'- `! Contractor's Name..----- - - - -- .. .��----��--•-•------------•-•-=- - ---- ............. Phone................................... �. Installation will serve: Residence 25 Apartment House ❑ Commercial ❑ Tra I e4y Court ❑ Motel ❑ Other ❑ Number of living units- __k_._. Number of bedrooms __ ___. Number of baths __�___. Lot size ....................... 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,date--------------------y No t New Co 1-struction: Yes ❑ No FHA/VA: Yes ❑ No jg TYPE OF INSTALLATION AND SPECIFICATIONS: - �,r ( P P P p --� �m..T,.-.T.,.ble.vvithin 20a feet._. -,-�= �� - l �. o septic tan or cesspool ermined if public sewer is avails � Spt;F ,Tanlc: Distance from nearest wellN__.Distance-from foundation -- Ivlaferia�� . - •. . -e--- �jG� � No. of compartments____r7 ____ _r Size _ Liquid depth_________ ____________Capacity..�.�. -- �—^+ j�,,�� Disposal Field: Distance from nearest welh-n:.1._0_._._Distance from foundation�_�• L_-3i !....._Distance to nearest lot lintf� ' ( Number of lines_____________+__ _________ .-Length of each line_____-.: 5Width of trench.___.— yy�� !i ! Type of filter material..._rC __ �__Depth of filter material-___-/r,-_________-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 from nearest well.................Distance from foundation---------------------Lining material--_-....______________---_---___-____ ❑ Size: Diameter_-,-------------------------------•-Depth--•---------------------------------------------- 'Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ C1Distance to nearest-lot line----------------------------------------------------••-------....----------•-------•------------•--•----------------•----••------------------ Re mod ng and/or repairing {dibeescr -------- ------------------------------------------------------------------------------------------------- .............................................. --------------•--•---••--------------------... • --------------- ............... -------- ---•------------- --------------•----------------------------------- --------------------------------------------------------------------------------------------------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County o inances, State laws, and rules and regulations of the San Joaquin Local Health District. ig ed)----..a... __`. - --------- ------ ]Owner and/or Contractor] BY ................:•---••.... --------------------------------------------------------------(Title)--------- �. ............. Plot n, 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------- =- - - ` `--------- REVIEWEDBY__._....... --- -- DATE_..--------------------------------- ----------------- DATE------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------- ........................ DATE------------------------------------ Alterations and/or recommendations:------------------------------------------------------' f- -- ...----•---------------------...... ........ -----------••--•-------- FINAL INSPECTION BY:.. --------------- -------- Date---- 1 SA�JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strout 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-89 204 S-6t ATLAS