15954 - Laserfiche WebLink

Home Browse Search

E: n F R91 E -------/�J APPLICATION FOR. SANITATION PERMIT Permit No. s -�---•�---• ---- -------- -- -------------------------- (Complete in Duplicate) 1 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. This application is made in compliance with County Ordinance No. 549. ` � � ------------------------------------ JOB ADDRESS AN LOCATION----- -----= - ---------- -•------------------- Owner's Name____... _ Address.............V�-3S _... �-.------• c7 ... Contractor's Name------- 'mac-� - �-�' --------••-•---------------------- ----------------•- .. Phone. - --------- --- Installation will serve: Residence gi—Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L___ Number of bedrooms ---4-- Number of baths ___t__ Lot size .................................... Water Supply: Public system �Community system ❑ Private ❑ Depth To Water Table +6 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_-.-----------------) No ff" New Construction: Yes gr No ❑ FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well__ --__Distance from foundation.�a--r----------Material_�-------____________ --------- No. ofcompartments-------- -------------Size---.3-X�-_ -- _ --Liquid depth.-.4....____.-_•------Capacity...�6-- ----- Disposal-Field: Distance from neai•e t well-'-_ Distance from foundation.h..__,...- f _ Distance to nearest lot line_________________ �.,� `___width of trench..._._Z `.----____,__.____-__ i Number of lines___________________________________Length of each line______ _____ �� Type of filter material...- 4_47______Depth of filter material...�k-------------- Total length------ ---•-•/------ f \ 5eepa .Pit: Distance to nearest well------ _�_______Distance�om founds#ion__�A......-------Dist ire to nearest lot line.:._.___.. p Number of pits---- ---•-•----_-_---Lining material_--(- G_!------Size: Diameter---_. --------Depth------ --...........•------ M Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------..._______-----______----- 0 Size: Diameter--------------------------------------Depth-----------------•------------ ---------------------Liquid Capacity-•-------------------------•gals. Privy: Distance from nearest well_____________________________________________ __Distance from nearest building-__________-•_.-______-------------------. ❑ Distance to nearest lot line------------------------------------------------ ----------------------------------------------------......---------------------•------------- i Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ ...--------•--•-•-------------------•••----------------- j -----•--------------•-------------------------------------- -•-•- ••-----------------------------------------------------------------------------------------•----- ------- --- ----------•------ --•-------------------------------------------------••----•------------------------------•-•---------•-----------••---------- -------------------.._....-•------------------- I hereby certify that I have prepared this applica ion and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and regulations o e S Joa in Local Health District. (Signed)-...---------------------------------------------- ----- -------- --- -- - Jo7ain Local and/or Contractor] By:-•-•---------------------------------------------- --- -- - --------•----------- ----------•-•--------------------------(Title)---------------------------------------.------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). RR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ----- --- ------ -- ---------------------------------------- DATE--- � -------------------- REVIEWEDBY-------_----- •--------------------------------------------------------------------•--------------------- ----••------------ DATE-----------------------•--- •---•--------------------•-•- BUILDINGPERMIT ISSUED--------------------------------------------------------------—------------------------------------- DA•TE-----------------------------------------------------.-----•- Alterations and/or recommendations------- ----- ------------- --- ---------------• •--------------------••----------••-----...._.--------------------..........----------------•---------..._ ----------•------------------------- ---... FINAL INSPECTION BY:.---------- _. ...... Date--------------------- �'---��-----•--------------•-------••--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,confornia Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS