15415 - Laserfiche WebLink

Home Browse Search

6777' 119G' FOR OFFICE USE. / -_ ............. ----- -""-- N FOR SANITATION PERMIT Permit No. __,l- - S ------------------ APPLICATION (Complete in Duplicate) ate issued _....__ _ - This Permit Expires 1 d Year From Date Issued Q O_O5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor erein ascribed. This application is made in compliance with County Ordinance No. 549. 7 pp - JOB ADORES D TION___-- -- --""-- ��'�s'�-� r Owners Name------------ ------- ----•-•- - -- r _ _ � Addre�s..,,.1 !� -------- Contractor's No f• .d C_k__.--•-•---. Phone./,/2!9 - ' Trailer Court Motel ❑ Other ❑ Installafion will serve: Residence %Apartment House ❑ mmerclal ❑ ❑ Number of bedroom- Number of baths ./ Lot size /0---•-•--..... Number of living units: -/- Water Supply: Public system Community system ❑ Private ❑ Depth To er Table ________ ft. Hardpan 0 I Character of soil to a depth of 3 feet- Sand E] , Gravel ❑ Sandy Loam Clay Loam ❑ ClaY ❑FHA FHAdobe A/VA.. s LJ No ❑ Previous Application Made: (if yes,date--------------------) No)4_ �ew Construction: YesA. No ❑ -TYPE-OF 71NSTALLATION-AND•SPECI FIC ATIONS:-;; � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P I Vim/ DIS Material--- Septic Tank: Distance from nearest w ILN--).____... tante `rom found - - ® No. of compartments_ _ __.---------------Sixe, -�6?L iquld depth____.. - -- .Capauty-- - r°P -_-.___Distance to nearest lot kine__..___..__..- � t - Distance from foundation-to f/ Disposal Field: Distance from nearest well_ "_ .•_Width of trench__-1-1-1-1--Length of each line___7J— ••- Number of lines--- � --- ----- 9 __ 6� De th of filter material....... "-------Total length..______ -------• Type of filter materia._ p _.-_.`.____, __Distance from foundation____________________Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well___Number of pits----•-------------`--Lining material-----------------------Size. Diameter__._.... Depth Cesspool: Distance from nearest well----------------- from foundation_-.._.____-________.Lining material-.__._...________---------- ----- ❑ Liquid Capacity. gals'Size: Diameter.I------------------------ ---------•-Depth-----------------•--- ----•----------------------- I _"_-_.-_--_--Distance from nearest building-------"------------ ••--------------- Privy: Distance from nearest well_____________________________ ❑ -------------------------- Distance to nearest of ine___________________._- Remodeling and/or repairing (describe.. -•------------•----------•---------------- ---------- ----- - C ------•- -------• -•-------•----------------- ---------•----•--••----•----------•------•---•----------- , --- _--- ----------------------------------------------------------------"-------------••---•-------------------------•------------•--------•----"------•------------------- I he certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, law , and-rules and re tions of the San Joa in Local Health District. (--------------------- -------------- Contractor) ter"---- (Si 9ne4 (Titl (Plot plan, showing size of lot, location of system in relatio we , bl%ildin , etc., can be placed an reverse side). FOR DEPARTMENT,U,SE ONLY APPLICATION ACCEPTED BY------ -`-- 1 ---------- DAT E------- 2-_tea-- --------------- DATE-----------•---•----------------------•---------••--------- REVIEWED BY------------------------------------ ---------------- - -----------------••- BUILDING PERMIT ISSUED•-------------------------- --------••----- DATE Alterations and/or recommendations--------------- ----------- ------- ---- ---- ----"---•-""'-" ----------- --- --------------------- ---•- -• --••------ -` --------•---- ---•------------------ ------- . FINAL IN ECTION Date-----1_�. - --------------•- - --------R....... SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 91h;atreet 130 south American Street �` I Lodi,California manteea,California Tracy,California Stockton,California E5 9 REVISED B-59 2M 5-62 ATLA5