15085 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . 5.1�.-.-- ------------------- --- (Complete in Duplicate). 6 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 complianc6'with County Ordinance No. 549. . ..--r--------•------------- --------••----_...-- JOS ADDRESS AND L CATION�.8ar- --------------- -------------- -�J'�-��'•`-=---....---- --------• Owner's Name---------- •-----• --- (1 {....... `------------- Phone 3----------••---- ------_-_---- Address-------------- +1 .. � ...�: ------------- -- -----•---•-.....,=•-------------------------•...................... Contractor's Narne..- ' ---•----•--- Phone----------------------------------- - Installation will serve: Residencewl,I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other [jNumber of living units: ._____ Number of bedrooms ._ Number of baths ----1. Lot size ___ _ _____________ - -- ----•---------------- Water Supply: Public system ElCommunity system [I Private;( Depth To Water Table __kp ft. Character of soil to a depth of 3 feet' Sand E] Gravel F1 Sandy Loam El Clay Loam ❑ Clay ❑ Adobe Hardpan C3 Previous Application Made: lif yes,date-___.__.-__-______.l No New Construction: Yes No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.) Septic Tank: Distance from nearest well__:_!�_®_._Distan a from found tion__=J=0::_::_--- I1 rl I___:_. _ �j ..---a o--f I 'x No. of compartments------A—_-----------Size�xlp_�--ate ---Liquid depth__--_.-- ---`?�----Capacity...-/�..__..--- I Disposal Field: Distance from nearest�ell---lP__S---Distance from foundation----/.�_........Distance to nearest lot line---- ----------- i Number of lines__I ------ _ ,l `__,_�_Length of each linesS7� a J iclth of trench._____ '------------- Type of filter material� l4Depth of filter material_______ -- --------Total material .length___.---------� _ -------------- Seepage _____________See a e Pit: Distance fntsrest well---- Distance efrom foundation ---_ Distance to nearest lot line................. 11 Number opI - -_Lining spiam -_- =------------ Depth-----------------•------------- Cesspool: Distance from no well-----------------Distance from foundation---_----------------Lining material..-_._______-_______...._______-----_ ❑ t __Liquid Capacity- -•-•--------- --gals-0— Privy- ...._— Size: Diameter ---- -------------------Depth----• -- --�---•-------�,;----::-�:�;.-�� -_. .. .. ----ga s Privy: Distance from nearest well------------------____________________-_--_-_-._Distance from nearest building_____.-_________-___-___._..__-________._. ❑ Distance to nearest lot line----------------------------------------------------------------------- -------------------------•-------------,------------------------------ Remodelin and oe Iy C + g / r repairing (describe):_ �'L ----------------------------------- ---------------------- ---------•----•-----------------•-------------------••------------------••--------•----------------------•--------------- .. ------------ ---------------------------------- I -------•------------------------------------------------•-------•-- -------- •-----------------------------•------------•-----•---------•---I--------•-----------------------------•----. ------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ` X11 (Owner 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). Ar FOR.I)EPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- ------------------ 4�_,;;;;�� DATE--------- REVIEBUILDING PERMIT ISSUED------------- !----------------- ---------------------------.----- --- -...------- DAT -------------------_ �--�-----:-- Alterations and/or recommendationst--------------------------------------------- -...-----._...-- '-••--------••-----•-----------------•--•-•----_---•-----------••------.. ..._ ________________ __________________________________________________________ __• I _____-- ____________________________________________________________________________________ I ______________________________________ .-___.__......------------------------------------------------__.-.__----_____.._--__________._.__--._-__._----__........---------------- a FINAL INSPECTION BY:.---- = = Date �.`�.�Y4~_S`---�---- ------------------------------ ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street, 205 West 9th Street Stockton,California i Lasilr California Manteca,California Tracy,California ES 9 REVISED 8-59 2M S-62 ATLAS r y ,