15251 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------/ -__--_.___.__.-_-.---.---------_--_-.- APPLICATION FOR SANITATION PERMIT Permit No. __ •r2__s-/ -------------•------•----------------------------------- (Complete in Duplicate) 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 Am work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION Owner's Name. ------ Phone-•------•---••....--- , , .__ �r. .�, _ 1, ._�----------------------- ----------------------------- Address-------------- •? -----------------------------------------------------------------------------------------------------------------------------•-------------.................................. Contractor's Name---------............ --------------------. -:----•--•----------------------------------••---- Phone.................................. Installation will serve: Residence @T Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- __/_. Number of bedrooms,. _. Number of baths /.may.. Lot size 4�� _//��___.__-....................... Water Supply: Public .system ❑ Community system ❑ Private [ErDepth To Water Table _ ____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: {If yes,date--------------------I No RT'O"New Construction: Yes 23-1Vo ❑ FHA/VA: Yes ❑ No 9 TYPE OF INSTALLATION AND SPECIFICATIONS:- ( s (No septic tank or cesspool permitted if public sswer is available within 200 feet.). Septic Ta k: Distance from nearest well 6�!-_..Distance fjo�n foundation ion___rirl--_....._-.M�a/t No. of compartments-------- de/th_-__fly+_..-._._-.-Capacity_ __... Disposal Field: Distance from nearest wnell--s __0_-._.Distance from foundation__JAP_._._.__.Distance to nearest lot line__.__._.... i Number of lines----------- Length of each line....A00_. ..._....._._--Width of trench--.aZ ---------- Type of filter material-106 Depth of filter material-----/ ____Total length__-__ _,_�'__________________ i Seepage Pit: Distance to nearest,yvell----Xd - ---Distance m fo nda#ion... t ce to nearest lot line--- �[ `� Number of pits______________________Lining material__ __.e..-Size: Diameter-__ --------DSpth_ _ ____.....-.._.... Cesspool: Distance from nearest well-__.-___-_--_-_Distance from foundation____________________Lining ❑ material.. -_--_...___-___-_______,______�_--------------Depth----------------------------------------------------Liquid Capacity--------•----••----------•--gas. Size: Diameter------------------------ Privy: Distance from nearest well--------------------------_--------------_-------Distance from nearest building------------------.............____-_-__-. ❑ Distance to nearest lot line------------------------------- -------- )t Remodeling (describe): �j and/or repairing (describe):------ �""�p ---------- :fie -- - ---------------•-----------•---------------------------------------------------------•-•-------------------------------------------------------------------------------------------------------------------- ---------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------•--•--------------• -----------------•-•----------------•-----------------------------••--------------------------------------------- --------- 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. ,' f (Signed)--------- Ad ------- --------------------------------------------------- or Contractor) By:------------------------------------------------------------ {Title) � /�� (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). p ' kl i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- --- ------------------------------- DATE----�---- ---7-.1—_6 - --------------------- I REVIEWED BY--------•---------t -------------------- DATE BUILDING PERMIT ISSUED-------------------------- - ------ DATE-------• -------------------------------•- Alterations and/or reco mend'ations:_. -- - ---- - -- -- ---_•-•. ..... ........--•------------------------------------------ �- -------------•--------•-- -----------------------------------------------•------------------------------ FINAL INSPECTION BY:---- ' - -- Date-------6- -• ------------ --- --------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Street 305 Went 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED $-59 2M 5-62 ATLAS