15366 - Laserfiche WebLink

Home Browse Search

FOR OFFI 1�1SE: ---- - f-- --------------- _-----.-__-.----.- 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 uin Local Health District for a permit to construct and i I t "tj scribed. This application is made in compliance with County Ordinance No. 549. nn��tt 1 1 - JOB ADDRESS AND LOCATION-----------------' ' - -------------------- ��jjyy�� /� ------ Owner's Name__-_�/_!C`„L, v----- -- -•-•• -•• ---- ----------------•-------------------- Phone.......................---_--. --- Address.- j 3 ... ......r....... -----fit ------------------- Phone-------------------------------------------------------------------------------------------------------------- Contractor's Name----- ... � 7-3 _ ;) Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----f___ Number of bedrooms __ _ Number of baths ___I.._ Lot size _________________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth ro Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------} No ❑ 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.) Sept' Ta -4 Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- I No. of compartments--------•-------------•--Size----------------------•---------Liquid depth--------•-----------------Capacity--------•---••f------- Dis� Distance from nearest well____�'_._..._Distance from foundation_-_f0___f ........Distance to nearest lot line.l,�...___..... ❑ � Number of lines-------- ------------------------Length of each line--- G_rt.P,�._--.Width of french---:43,r.-'_____._...;______-- Type of filter material._.�G4 -------Depth of filter material__/&....------__.Total ler<gth------L.C2_._____..S-��----_--•- 5 e it: Distance to nearest wall_.__`_"____----__Distance from foundat -..Distance to nearest lot lin _ Number of pits__ ” -____Lining material__-.Size: Diameter"...____Depth______'.-.--- Cesspool: Distance from nearest well----------------- from foundation------------.-------Lining material..----------------------------------- 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------- ---------------gals. Privy: Distance from nearest well----------------------------------------- - -----Distance from nearest building.______-•.---_________------_______-----_. ❑ Distance to nearest lot line-------------------------------------------------------------------------•---------------•-------------------------------•---•------------•--- Y Remodeling and/or repairing (describe):------------------------------------------------------------------------------- -•--•-•-------•---------------------•-----------•--------------------- --------------------• ---------------•-----------------------------•---•---------------•---------------•------------•---------•----------------•-•-----------------•----. ----------•--------- 1 hereby certify that I have prepared this application and that t work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San J q ' Locai Health District. (Signed) ---------------------------------------------------- --- ------------ - -------- ------ --------------------------.---------------(Owner and/or Contractor)' By:-----------•-------------------------- ---------------- -------- --- -- --u------ ----- ---------------------------..._(Title)---•-------------------------------------- --- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED_BY -- '----,-- ----------------------- €SATE-------1------•--��' �--.-��------- REVIEWEDBY-----------------•---- ---•-------•-------------- - ------------------------------------------------------------------------ DATE------------------------------------------------------------ 'TE PERMITISSUED---------------------------------------------------------------------------- ------ DATE---------.-.---------------------------•----- •-------------- Alterationsand/or recommendations:-------------- ------ ----------------------- -----------------------•---------•-------------•-••----•----------------------------------------------------- --...------------------------------..------------------------------------ ---------------------------------------------.----------------------------.-•----------------------------------------------------------------------- -----------------.......................... -•------••----------------•---------------•-------------------- -----------•---------- --------------•-••------------ -------------------------- ----------------------••-- ,'I-, —/ � FINAL INSPECTION BY:_- " � ---------------•----- Date_---------- ---•----1.._ r--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wit 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E3 9 REVISED 8-59 2M 5-6Z ATLAS