15136 - Laserfiche WebLink

Home Browse Search

FOR OFkI �- -j APPLICATION FOR SANITATION PERMIT Permit No. ...�C_- - :.... --------- --------------- ------------------------------- (Complete in Du Duplicate) I `?� P I 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 here-inn scrb . This application is made in compliance with County Ordinance No. 549. d J, JOB ADDRESS A/D LOCATION ' �!G'•a"" "__ L '�---�j-�- = �� - -�Gl �r y Phone------------------------------•---. Owner's Name fir'!: 6 ---------------------------------- �� 1 ' Address. .. ...................--c------------------------ ---------------------.....__.. ----------------- -------- Contractor's Name ... ------------------------------------------------------------- Phone Installation will serve: Residence Ey Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-I--_- Number of bedrooms -x5_. Number of baths .n Lot size 11 �Q_ -...r,39_... Water Supply: Public system [ICommunity system Er ivate [:] Depth To Water Table .6D ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n--Hardpan ❑ Previous Application Made: {If yes,date------------------1 No e New Construction: Yes 2KNo ❑ FHA/VA: Yes 0--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + —� from foundation_l��.r_._---_-.Material-_---I ____________________r..__. Septic nk: Distance from nearest well-----------------Distance p No. of compartments_-_ - _--------------Size-----' `�C/ Liquid depth----f__...................Capacity_-��Q�a Disposal Field: Distance from nearest well..------_..-_Distance from foundation_/01...........Distance to nearest lot line.4e-----__-.--- (� Number of lines........2—------------------Length of each line------76-7 t---------------Width of french....Af_`----......-________ Type of filter mate rial._,��_KA,-----------Depth of filter material-----/$""---------Total length........b -------------------------- Seeps -Pit: Distance to nearest II__'_______________---Distance foundation_ilL.F.........._.Distance to nearest lot line_��----------- Number of pits_______ ____________Lining material..----- -----Size: Diameter__. -_- --------Dept h-------_Z0 7-`-__________- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter----------------- Depth---------------------•------------------------------Liquid Capacity...........-----------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------_-._-__-_-_--_-__---____-------_-. ❑ Distance to nearest lot line- --------------------------------------------------------..-------------------------------------...------------------------------------- f Remodelingand/or repairing (describe)-----------------------:--------------------- ---------------------------------.....-•---•-••----------------------------------------------------- ----------------- ----------------------------------------•----•-----------•--•------------ --------- -....-----------•--•-----------------------------------------------•---------------•------------•------------------- I hereby certify that I have prepared this p• 1i: Ion and hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulat ons a/anoaquin Local Health District. (Signed)------•------------------•----- ---•--•- ---------------- - -- (Owner and/or Contractor) By:--------------------------------------_------- --- --- ----------------------•-------------------(Title)---------- --------------------------------- - .............. (Plot plan, showing size of lot, loc on of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY ------------------------------- DATE---1 a APPLICATION ACCEPTED ACCEPTED BY_t�/ . REVIEWEDBY----------------------------•-------------- ------------------------------------------------------------------------- DATE----------.--.-------------------------------------•------- BUILDING PERMIT ISSUED------------------------------------ DATE---------------------- - Alterations and/or recommendations:_ 'l/s__._ _._. -� � �i.- rte{---- =�-P ------- �`'�- -?- -----------------------------------••- ---- -------- ----_---------------. ------- ----------...------------------------------------------ -------------------------------------------------------------- ----- -----------------------------------------•---•------------------------------------------------------------------------------------------------------------------------------ ------------------------------ --------------------------------------••. . . --...------. --------------- ------------------------- --•----------------------------------------------------- -------------------------------------------- ........ OFINAL INSPECTION BY-.r._. Date-.-��;Illla---- ----------- -------------------- /ANI.XQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 ZM 5-62 ATLAS