15533 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: :------------------- APPLICATION FOR SANITATION rCRMIT Z� �Permit No, ......:��.��..:� _ .- -•4 (Complete in Duplicate) //fa . .�..------- Date Issued ---•--�-- --� _.__..._._ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin'Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANM LOCATION_. d . . ... ---------------------- Owner's Name------- --• Phone-------------- --- •---•JJ----- ------- ----------- --•---------------- Address..................--•------- --•------- --N im ----------- --•---------- - Contractor's Name------------------------_-- ------------------------•---------------------------------------------------------------------- Phone. ................. } Installation will serve: Residence Apa ment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ❑ p ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ------.. Lot size ------ ,_._I-------------.3..................... ` ! Water Supply: Public system ❑ Community system ❑ Private ❑ Depth ro Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑/Sandy Loam X Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------.------ -) No ® New Construction: Yes ( No ❑ FHA/VA: Yes ❑ Nol� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well__ _ _ _ '�tanc from f�ybbund tion_____- _0........Maton- 1__._�,�__ No. of compartments------x��__._...5ile_ �___ --t;k_Liquid depth..... -Capacity-/j Dispo al Field: Distance from nearest well. �:"Distance from foundatipn-----__•____._......Distance to nearest lot line----___--:-- Number of lines.._.. _____. ___Length of each line...,--p-Q __ Width of trench___��_ 1 ..... ----- --------- Type of filter material.�1` ?" __Depth of filter material--- Total length_____`I�_Q___ __ ____ �g�,y,�.rr--- Seepage Pit: Distance to nearest well----------------------Distance from foundati n____._...._..._.___.Distance to nearest lot line----------------- F1 Number of pits.---------------------Lining material-----------------------Size: Diameter-------------------....Depth----- _--.----.-----.--------- Cesspool: Distance from nearest well-----------------Distance from 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 repai inc� (describe):___ _ �. _.. .._ �.____�C. __ _ -- - . - -- -- .� -- ------ '- -----�®- -�- -------- --------- -�� - - - --- - --- ---- ----- --- - ----- --_ _- ------ ------ W,lw-----�--------------------------•--------------- _ _ ._.__ �__-. .. Y________________ ___________a____.__.... .._ I hereby cert' y that I have prepared this application and at the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of thIg n aquin Local Health District. ----- ---- k ---- ------ --------------------------------------------------------------- Owner and/or Contractor [Signed.----------- ------ � --- - - - -- { / 11 By:.......-----------------------------------------------------------------------------------------------------------------------------(Ti+le)-------------------------------- ------- .....------------ (Plot plan, showing size of lot, location of-system.in relation to wells, buildings, etc., can be. placed on reverse-side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------------- --- -----------------------• - DATE-----------------Z41__ REVIEWEDBY---------------------------------------------------------- DATE -�, --a ° `� BUILDING PERMIT ISSUED----------------------------------------------------- - - -------- ------------------------- DATE------------------------------------------------------------- REVIEWED and/or recommendations-.--------------------------------------------------------------------------------------------------------------•---•------------------------------------------ --------------------------_---------------------------------------------------------------------- -----------------------------------•---------------•--•--•---------------------------•-•--------•----------------------------- ---------------------------------------------.-----------------------------------------------------------------........... ---------------•--------------------- •------------•---------•---------------------------•--------------- ------1---------------------------------------------------.------------------------------------------------------- --------------------------------------------- -------------------------- - -------------------------------------------------------------------------------------------------- --------------- -------------------------------- ---------•----------•-------------- ------- --------------------- ----------- --------------------------------------------------------------.-------------------------------------- ----------------------------------- FINA!_ INSPECTION BY: - - ------- ---•----- Date.......5;- -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 a-59 2M 5-62 ATLAS w