15040 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: o ---------------------------------------- r----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...,� .`T`a -- ----------------------------------------------------- (Complete in Duplicate) Date Issued -.//j____ _Q___� _ .__ ----------- -------------------------- This Permit Expires 1 Year From Date Issuedi 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.--A-O--l-4....... `•^'- ---------------------------•------------------------------------------- Owner's -••----------•--------------------------Owner's Name-------•-----CU 6 4�1�v vtA ( -- - Phone_.. ..i.. = --- � x Address ►CC — � . . . �c� ---r�--------------•---------- r r Contractor's Name--•---=M _sem.-_- .�_'_.L._S_"''�. ._. �.. A-tt�-C, Phone---rf �� J Installation will serve: Residence E+ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other, ❑ Number of living units: _I_ Number of bedrooms . ___ Number of baths J.... Lot size ....��_�.f...�.__��`._,��_-•................ Water Supply: Public system 0�__Commuriity system ❑ Private ❑ Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ O Previous Application Made: (If yes,date--------------------) No 0r' New Construction: Yes ®'No ❑ FHA/VA: Yes [] No B--,N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -SP.,ptic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material..........---------------------................... No. of compartments---- ...-----•---------Size--------------------------- ---Liquid depth--------------------------Capacity------•---•---------- Dis oFi : Distance from nearest wel psal I,rx .Distance from foundation-._ -. f_........Distance to nearest lot�ine__. ........ Number of lines____:_�.. - __________________ Length of each line._______________ . __...Width of-trench._ _-__ __ ___ Type of filter material ___ _ -----Depth of filter material _.._ ______.____Total length_____ ..-- __ Seepage Pit: Distance to nearest well_��_f�i,,__.- Distance from foundation-----I._�___.......Distance to nearest lo�ne...�'........_._. Number ofpits-----l----------•_---Lining material.-_12—-tZ------Size: Diameter__33-------------Dept h__Z...... ---- r L-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------..._.________--.-- [❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity.---------------------------gaIs. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---......_._________-_-_-_.-_-_--___-__.-. ❑ Distance to nearest lot line-------------------------------------------•-------------------------- Remo ell 4wd/or re ring (des e)_ _____ Its (��-_ -t � 9 �' «i ---- . ---------- 100 ------ ---------- --------------------------------------------------------------------------------------------------------------------•---- ------------------•--------------------=-------------------- 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. n Si ned �- w___- - - ti i ---:1-{�- ---------------- -- ----,---------(Owner and/or Contractor) R`k?------------___----------------------------------------- --------{Title}....- -ern"{ r:` (Plot plan, showing siz f, location of system in relation to wells, buildings, efc., can be placed on reverse sid ). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- DATE ..s REVIEWEDBY-----------------------_------ -----------._.. DATE........................................... ---•---•----------------------------------------------------------�..-----•--•--•----•--------BUILDING PERMIT PERMIT ISSUED----- -------------- ------------------------------------------------- DATE------------------------------------ Afterafions nd/or recommenctm 'ons:.---•- •---- -- - - -- -----------------------•----•------•------------------------------ 6 -- == ----•--•--..--------�_ --------- - -------- ---------�,�----------------------------------------------•---. ------__ ---------------------- ................................... ----- ------------------------------------------.....-------------------------------------------- FINAL INSPECTION BY------------ ---•---- ------------------------------- Date--------- 1 SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street "300 West Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-89 21A a-GI ATLAS