14142 - Laserfiche WebLink

Home Browse Search

` FOR OFFICE USE: ? - --------------- -------------------------------------- / ________________________________________ ______________ APPLICATION FOR SANITATION PERMIT Permit No. ...�. � .. ------------------------------------------ •--------- , (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 2Wiinftil the work herein described. ~ This application is madeln compliande with County Ordinance No. 549. JOB ADDRESS AND LOCATION __10---- Owner's Name. --- Acine....................... Address-------...13 °7.�.- 1 -s Contractor's Name--- _214,.---------- ", --------- ---- -------- -----------------------------------------------------•--- Phone.........•-•---.................. Installation will serve: Residence Apartment House ❑ Commercial ❑_Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms .-_ . Number of baths.__L___Ldtfsize ---------------_--------_______________ Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table 7.0-. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_____________________' No New Construction: Yes X No ❑ 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_Z ------- Distance f om foundation--447._________.Material__�fi'1 :....................... No. of compartments-- - ------------------Size- _-- --'�t _______._--Liquid depth--------- ---------------Capacity, -. Disposal Field: Distance from near t welL� "___.Distance from foundation_J-0—-----------Distance to nearest lot line______---_- p �] yP l - 9 1 - ----------------Width of trench-- -y ............ Number of lines__: ____ __ Length of each line____ 1_D_ T e of filter materi Depth of filter material__ '______________Total length__ !.Q_..._______ __________.. i Seepage Pit: Distance to nearest well_.____----"___""____.Distance from foundation....................Distance to nearest lot line----------------- a F1 Number of pits----.................. Lining material----------------------.Size: Diameter-----------------------Depth..........._.---.---..-.----_-.-_ Cesspool: Distance from nearest well-------- ? Distance from foundation--------------------Lining material..---.--------------._______---_•--_- El Size: Diameter----i--------------------1-------- ....Depth-------.--- -----------------Liquid Ca aci als. Privy: Distance from nearest well-----------------------------------------_-------Distance from nearest building------------------------------------------ IDDistance to nearest lot line--------------------------------------------------------'-•-•---------.---------•---•----•-------------------------------------------------- 1 Remodeling and/or repairing (describe);------------------------------------------------------------------- ------...:---•--•-•---------•------------•------------------------......---._........ I _______________________________________________________________i.___--_--_--__________•_-_____-_--___._______________________-_--,-.__----_._. ________-............_____------ '.____._______.._____.____________...________.___. - x . -------------_--------------------------------------------------------_______________________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that thJ work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned g ) G L S— - ----- ---------------- ---------------(Owner and/or Contractor) a Title (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-- ;,a -- -- ---------------------- DATE ---_��. ' -, ------------ ---•---.-•------ -. REVIEWEDBY--------•------------------------------------ •-••------ •------. DATE------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- •--••---------- DATE------------------------------------------------------------ Alterations and/or recommendations:------------------ ---,=-------------------------------•-•---------------------------------------------- ----------------•---•------------------------••----- i. 1 I I - - FINAL INSPECTION B : - } ----- Date--,/--/f Date ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strout 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California. ES 9 REVISED 8-59 ZM 5-At ATLAS -