15325 - Laserfiche WebLink

Home Browse Search

IlUKUl-F-K-1: USE: T` --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . __S - ----- ------------------------------------------------- (Complete in Duplicate) ----------------------------------------- �" Date Issued �.�.... --------�--- This Permit Ex fires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe �1 stall the work herein described. This application is made in compliance with County Ordinance No. 549. 2-0 0—7 JOB ADDRESS AND LOCATION- Ir - Owner's Name - -------- Phone_..----- .. •----- ----------------------------------------------------------- -------------------------- Address. �• --- -- f ------------------- - -- ......................................... Contractor's Name..-- . ........._ --- •---•------ Phone................................... ---- --- -- ----------- ------------------•-•-•--------------------• Installation will serve: Residence 4 nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: L. Number of bedrooms _,;L._. Number of baths _1___ Lot size _ Water Supply: Public system ❑ Community system ❑ Private R Depth To Water Table . ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan p ❑ ❑ Y $) Y ❑ Y ❑ ❑ P ❑ Previous Application Made: (If yes,date--------------------) No 9d New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 206 feet.) Septic Tank: Distance from nearest w _4770'-!-_Dista ce from'foundation__l_6-----------Material-. _ -__. W '}j> No. of compartments - _Size_�:-�'9!K_1. �• ---Liquid depth---..---------------Ca Capacity-3,17-�17_6_t?.:._ p tY Disposal Field: Distance from nearest welL�f7_--_�-Distance from foundation---®_q --------Distance to nearest lot line..4�___._��+ Z [� Number of lines_-..:�----------------------1 Length of-each line-----.�0------------------Width of trench.__,cZ,.jA-'' ............. of filter materia R; _Depth of filter material-----f__�___-______Total length---/t.d!___________________------- Seepage __Seepage Pit: Distance to nearest wet___________ ________Distance from foundation....................Distance to nearest lot line_____________--_- I f ❑ Number of pits----------------------Lining material------------------ -- Size: Diameter-.--.------------------Depth---------- -------------------- Cesspool: Distance from nearest well________ _Distance-fr`om foundation--------------------Lining material-----------.--______-_ ❑ Size: Diameter---------------------------•---------Depth' ---------------------------------------Liquid Capacity gals. Privy:. Distance from nearest well--_-_-_-___________ ____ -----------------Distance from nearest building Distance to nearest lot line-.-______________________ ------------ Remodeling and/or repairing'(describe):_____---- -------------•---•----------•-----•-- 1 ---- ------y ---------------------------------------- =_ -•-------•-------•-----• -----------------••-•-----•-------------- ------- fA 'f - f - __________________________________________________________ ___________________________---______-. .__«---___--_______-__--_--_______--__________--__--____-____-__._____..___-.___-___________-___.____________.--__-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat law�ndlesand regulations of the San oaquin Local Health District. (Signed)-- -- •-- - ------------•---------� -- -- -'G''� ---------- ---- ---------------------------------------------------------------------(Owner and/or Contractor) By: ---------------------- ------------------ - - --..=- - (Piot plan, showing size of lot, location of system in relation'to wells, buildings, etc., can be placed on reverse side}. .n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED � --------------------------•---------------------------- DATE--- Z REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE---------------•---••--!- S3 ---------------- BUILDING --- PERMIT ISSUED------------••---------------------- -----• DATF. Alterations and/or recommend'ations_____________________ ---------•------------------------------------------•----------••-----------------------••---------------------•-•--------------------••--------•••------••----•-- --------------•----•-•-•------ -------•--------•--------•------ --------------------------------- -- ---------•---------- ------------------------------•-----------••-----------•----------•------•------------------------------------- FINAL INSPECTION 2----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS