14966 - Laserfiche WebLink

Home Browse Search

-._._-.--__.__. ---------------------- ---------- APPLICATIO13 FOR SANITATION PERMIT Permit No. --------------•----------------------------------------- (Complete in Duplicate) --------------------------------------- --- ------ This Permit Expires I Year From Date Issued Date Issued o F 3 3v-&f, Application is hereby made to the San Joaquin Local Health District for a permit to construct and-insta the work rein described. This a plication is made in complia a with Count Ordinance No. 54 . Z4 ,sJ- K�'w i Yti - � JOB ADDRESS AND OCATIO � r s'; e"� """o ' �t.?` .:._.. u � f Owner's Name__ _ .�- - ---- --------•----•--•---- ---- -•-•------•• ----------•-----•-----------------•- ----------.____.p _.__. Phone__ y� n -._._ /� �'' ,� �--• --------f--�--� --- Address `' 'aXl" +=" r ```� ��_A�-•----- Contractor's Name... �l� ... - - --•11 • -... C w............................... Phone.. .......C.. TI Installation will serve: Residence ®-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _ Number of bedrooms ._Number of baths Z_ Lot size .._.._._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San oam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,dote____________________) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ -� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is T Distance from nearest well_________________Distance from foundation--------------------Material................................................. No. of compartments--------------------------Size.----•--------------------------Liquid depth---------------- ---------Capacity....................... + � t sp al �: Distance from nearest well_/.f_49_9_r._Distance from foundation----A� =Distance to nearest lot Number of lines_____ ---------------- -----Length of each line------- ___�-r...._.__ Width of trench_ Type of filter material._ i Depth of filter material...-___,1Y- ----Total length-,,,...----------------- Se e ength...............•__-------•Seepage Pit: Distance to nearest welLf�T'LZ----------Distancefrom f undation__.._4.49......Distance to nearest lot line...... _4 ed►� Number of pits-------I------------Lining material___ r_.-.Size: Diameter_...._ Depth----- r....... .---- Cesspool: Distance from nearest well-----------------Distance from ound6tion___.______-____-.-.Lining material----------------------------..___---_ ❑ Size: Diamefer-_-•----------------------------------Depth-----------------------------------------------...._Liquid Capacity-----_----•-------------.-gals. i Privy: Distance from nearest well__________________________________________ _____Distance from nearest building---------------- ------------------------ Cl Distance to nearest lot line. ---------------------------......------------------------- Remodeling and/or repairing (describer , ------------ ---------------- ------------- OF --_4x - ---- ----• •--•--------•------•------•-•----------------------- •---------------------------=------------------------•----------.......----------••---------------------------- --- ---- I hereby certify that I have prepared this application and that t e work will be done in accordance with San Joaquin Coun ordinanc�StatS, an rules and regulations of the S Joa uinL ealth District. (Signed)- ---------- �1� 1 Contractor) By:_---------------------------- ---------------- ------------------------------------- -- - - - --- -------- ------(Title)__..---------------------------------------- --- -------------- (Plot plan, showing size of lot, location of system in relation to uildings, a ., can be placed on reverse side). FOR DEPAktMENT USE ONLY f APPLICATION ACCEPTED BY------ '= . •• ----- - - -----------------------------••------------- DATE---L�...T - - -- REVIEWED BY__....._.. -------- DATE_-. n BUILDING PERMIT ISSUED-------_- --------------------------------------------------------------------------- DATE !l Alterations and/or r9comrpendations:. --- ........ --------- --- --- ��..... .. ... . ----- ------------ - ---------------------......................................................... --------------------•------ --------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:..----�J — Date.----- ---�---� �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-59 $M 8-61 ATLAS E'