15906 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. ------------------- ------------------------------------ (Corpplete in Duplicate) `3 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 compliance with County Ordinance No. 549. SpW7-11 p - 1/ ON 4 - _. JOB ADDRESS AND LOCATION..9.�--/_-----.5��', f"�6......................----.._........7--- TO/YE-----�_ -U psi-----.fPc Owner's Name..../V=------ —-------- h' -- ------------ Phone.ff� s ` . � 7 Address--------------- / -----------------------------------------------------....--------------------------------..-----------------•--------------------------.................---------.. Contractor's Name......2_>e_f.J_�------ __ Phone -310.6?,ro Installation will serve: Residencer"Apartment House ❑ Commercial-E).. Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms .,7t Number,of baths',./---- Lot size ___7l- __X__ 2?............................ Water Supply: Public system ❑ Community system ❑ Private ;� -De'pth.To Water Table Oft. j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 2o"Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E[ New Construction: Yes ❑ No JIM FHA/VA: Yes ❑ No Eff I 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----- Distance from foundation____.�Q..........Material......� =f ................... ® No. of compartments------------ Size_J_x_.5'_?_<----I--------Liquid depth------- __r _..____Capacity.-�4_�'?��- Disposal Field: Distance from nearest well--_,�=0!---Distance from foundation....1 -�_.___.Distance,to nearest lot line_____s ..-_.- Number of lines-------------- `__--_Length of each line---------- of trench----------A-V----_.__._--- Type of filter material--- Depth of filter material------- -Total °length-------------------22'4.�-�--------•-••-- Seepage Pit: Distance to nearest well----l.D0_.........Distane-from foundation____-/,'1........Distance to nearest lot line_____ _ -- ® Number of pits___________________Lining material..AQP_____-Size: Diameter_.._-.3 _--_____r.Depth__-_:____-S=...... ....... i well______________.Drstance from foundation------------------- material____._______-__-_-_-;________________ Cesspool: Distance from nearest 1 ❑ Size: Diameter------------•-------------------------Depth----------------------------------------------------Liquid Capacity----------•------••- ----gals. Privy: Distance from nearest well------------- _.- --Distance-from nearest building-------------------.........._-__________- ❑ Distance to nearest lot line------------- -------- ---------------------- ---------------...................._...---------------------------------------------.-•-------- ItRemodeling .and/or repairing (describe):-------- ` ""'j �r ' -----------•-•---•----••----••--------------- r --------� - �`�,, p.- ....................................-•--•--------------•----------------------------------- --------------------•------•---•--------------------------•--•-----•---•----------------••---•---- ---------------.......-----'. ---------------------------------------------------------------•-•-•---------------•-�--••------- -----------;---------F------------------- ----•-----•----------�------------------------------- -------------------- -----------•------------ -------------•-•------•--•----------•-----------------.----------------------••---•------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be donerin accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �-- ------------- Ow er and/or Contractor I -- { t (Signed)_-•----•------------- ------------e-------------------- - - ------------------------------ I._�/f ' - --------—- --------------------------------------------------------------(Title)-------- ,ca.----------- ---------- (Plot plan, showing size of lot, to ion of system in`relation to wells, buildings,,etc., can.69 placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' = --------------------- ----------------------------------------------- DATE =f REVIEWEDBY-------------------------------------------------- --- -----------------------------------------•---------------------------- DATE...................---------------------------------------- BUILDING ----------- -------------------- BUILDING PERMIT ISSUED----------------------------- D6TE--------------------------- Alterations and/orrecommendations: /��+�� -p `.�.... < ------ .................. ----------- �r�° � r -�-1----�-•------------------ -. ' ------- ------------------------- e '..re-- ��_e^-'�._c [r-cS�-•-L� --- =-`--'=`-�z-------�`--- =-. •-l--Q-P�-s' Co-. �� zti 4. L�LC, ._._.-- ______________ ..-.-_..t-._.__`__._._____.__..__.._____--_.-_._-__.-_--..-.______-_____._.-___._________-.-_______.. ________.________._._______-__.-____-__________.____..__-..____________-__ � .w FINAL INSPECTION BY:...---- .-_----'_._-__. 7 �- i Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wed 9th Street Stacktonr California Lodi,California Manteca,California Tracy,California E5 9 REVISED 5-59 2M 5-62 ATLAS