15055 - Laserfiche WebLink

Home Browse Search

FOR OFFI E _.-.. i% APPLICATION FOR SANITATION PERMIT Permit No. . --------------------------------------------------------- ; (Complete in Duplicate) ft`1 ---------------------------------------- ---- b This Permit Ex Tres 1 Year From Date Issued Date issued .._............ ��Z-- Application is hereby made to the San Joaquin Local Health District for a permit to construct a install the work herein described. This application is made in compliahce with County Ordin ce No. 549. JOB ADDRESS AM LOCATION..-_ -. _ •- ��I� ------- Owner's Name.--- e ------- ------- hon Address <-r-•------ -------- ... ---- ---- - -----°�--------f :............................... (T -------------- -------- ` S!Ct--- Phone----- s`Le..�' _/ Contractor's Name-- Installation will serve: ResidenceApartment House E] Commercial [3 Trailer Court 0 Motel C] Other ❑j Number of living units: . Nu ber of bedrooms _-- _-: Number of baths -f----- Lot size _ _ �-..�C..,(. ................... Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table,31_ ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ 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 200 feet.) Distance from nearest well------ ----------Distance from foundation-_._.-.-----_---.-Material-----.-.---.-.--._--.----_-_-.._--...._.---------- %f' No. of compartments---_---._---"-----------Size---EM:- Liquid de th--------------------------Ca aci _ , q P. P +Y Di salLld: Distance from nearest well__-�1-b from foundation--LO_ --_-_-Distance to nearest lot line............ Number of lines___ff--- - `" Leri th of eachfine. ._ f dth of +ranch.- /�T 1 -. g 1¢A6- --- ------.W� c'.44-------. -------- Type of filter material. ----Depth of filter material..--.�_-C� - Total length_-.--.•---__----__-,1.0-_-_-_..--._ See page Pit- Distance to nearest well-W----------------Distance from'foundation---_--/Q......Distance to nearest lot line._ - Number of pits---I-----------------Lining material.RR!.C� ---.Size: Diameter-Z - Depth Cesspool- Distance from nearest well-----------------Distance from;foundation--------------------Lining material__..----.-_-.-----..-_._.---__------_ Size: Diameter---------------------------------------Deth-------------- ___------------------------_----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-------_--_._.-__-.----_----.--------.-. ❑ Distance to nearest lot liner ----------------------------------- -----------------•------L.-•--------------------------•---••--•-•----------------------------- Remodelingand/or repairing-(describe):------- --- --•- -------------- -------------------- ------------•------------------ - ----- ------ - --••--------••----------------------•- -----------------------------------••---•-------------•--•---------------------- ----------- - ------ ------•------------------- -- { --- --------------------------------------------- I hereby ce 'fy that I have prepared this app ication and +hat the work will a done in accordance with San Joaquin County ordinances, a d rules and regulations of he San Joacui L/oval alth District. 4 Contractor (Signed ------ - - --�-- -- .+�� - - ---- -- - -- -- --------- ---- -- -�-�-f----------•----------------- - - ----- ---�--.....-.---- ----- � By=----------------------------------------------------------------------------------- - -- -- - ----- -(Title)._... ---------------- -- ----- - (Plot plan, showing size of lot, location of system in relati n o wells, buildings, c., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. -------rt-�"'Z.------=-------------------------- ---------------------- ... DATE Hyl n.: - REVIEWEDBY--------------------------------- - ------ ---------------------------------- ----------..--------------------------- DATE------------------------------------------------------------ BUILDING PE MIT ISSUED------------------------------------------ ----------------------------------- DATE------------------------------------•------------------------ Altera t ns an or recornmen ions' _----. __ . --.._.. � �� _,C,�-�--...... 7 = - -------------------- -------------- FINAL INSPECTION BY:.------ - Date--------/ 1 '� - —r ,// 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 Tracy,California ES 9 REVISED 8-59 21A 5-62 ATLAS