15098 - Laserfiche WebLink

Home Browse Search

.._--- APPLICATION FOR SANITATION PERMIT Permit No. ..l.01 f S l�..l_.. ----------- ----------------------------- ------ (Complete in Duplicate) ___�_...� Date Issued / -�--- ----------- --------------------------��----.--. This Permit Expires 1 Year From Date Issued 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 4 e.- lofoe Owner's Name-----•�----�e-7- ----- --••-----------------------------------------------------•------------------------------- Phone.................................... Address. ................ - -----••---••-- ---------------------......................... Contractor's Name---------•---_.. -' Phone................................... Installation will serve: Residence leelAPartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _f2-_ Number of baths .l____ Lot size 7................................. Water Supply: Public system Community system ❑ Private ❑ Depth To Water Tablee� . I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M-11ardpan ❑ Previous Application Made: (If yes,date____________________) No JR-- New Construction: Yes ❑ No ®.' FHA/VA. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: , Distance from nearest well_________________Distance from foundation---------...........Material------------------------------------------------- �� No. of compartments--------------------------Size--------------------------------Liquid depth--.--.--------------------Capaci Disposal Fields Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line................. Number of lines---------------•---------------------------------------Length of each line------------------------------Width of trench.----.-.--------------------------- 7 Type of filter material_________________________Depth of filter material____.-....__-_-_--.-.-.Total length_______________-__•-•_-__--_--_--•----_-__ See a e Pit: Distance to nearest well----- Distance fr m foundation____ � p g ,e�p____._..D�sta��e to nearest lot li�e__�-__._.-_---_ Fir Number of pits-------/-----------Lming material__ QSize: Diameter__ . ____...___Depth_. _t __�________________ Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material__.__._-_-.-__-.-_-------.--___-_._- IJ Size: Diameter----------------------- --------------Depth----------•-----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance.from nearest well-._._---.---- ______________________ _______Distance from nearest building-____.._________-_________-___.__..___.._. ❑ Distance to nearest lot fine - ------------------------------------------------ - ------- *---------------------------------------- Remodeling and/or repairing (describe):------- (� G�r„----_•- -'---(/ j -----------------------------------------------------------•------------------------------------------------------------------------------------•------------------------------------------------•------•--•--------------- 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, a rules and regulations of the San Joaquin Local Health District. (Signed) A ------�. ------------------------------------ Contractor) By: Title (Plot plan, showing size of lot, location of system in �afliionwells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY-=i f- "' .------------------------------------------------------------- DATE ( REVIEWEDBY-------------------------------- ---- ------------------------------------------------------------------- •--•--•--•---._.. DATE..---------------------- -----------.......- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------------•--•------- Alterations and/or.recommendations-----------------------------------------------------------•-----------------------------------•-••-•------------•-----•-------•------------------------ ------ ....... _ ----------- J ... .v e 1�4........I _1- ------------------- FINAL 'INSPECTION BY:-----f -- Date--------- _-- �- . 7 ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th street Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS :L _