21558 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------------------------------------- ------------------ -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._�_��..5~� --------------------------------------------------------- (Complete in Duplicate) Date Issued ----- --.--. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...1 ,V._ L_..�- -----------------------------------•-------- -------------------•-- Owner's Name_ �j� � / I �_:.. .CY_L9.�Tl- � Phone a------�--------- --- Address........"0-p.......eVa-'t-- Contractor's Name.-.--------------S Gt- Phone Installation will serve: Residence ❑ Apartment House Q" Commercial El" Trailer Court ❑ Motel ❑ Other ❑ -� Number of living units: _AZ_ Number of bedrooms __-q__ Number of baths ._ Lot size ...._/B-4..k../., C1_.. r�_r ':._.... Water Supply: Public system ❑ Community system v" Private ❑ Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam d" Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ `~ �i Previous Application Made: llf yes,date____________________) No ❑ New Construction: Yes ❑ No 2' FHA/VA: Yes ❑ No R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septi tank or cesspool permitted if public sewer is available within 200 feet.) Sept k;l) ' ante from nearest well_______________-Distance from foundation....................Material............................................... .. N . of compartments-------------- ---•---•--Size--------------------------------Liquid depth------------------.-------Capacity........................ Disposal Field: Distance from nearest well-57-t"Distance from fou ndationJ.0A-.:t'..Distance to nearest lot Iine.QY!�9�.5 Number of lines----------Z---------------------Length of each line------------------------------Width of french---- .v2 Type of filter material...S__T_� epth of filter material.��._.__________.Total length-------------- �_---.._. y�,�111� Seepage Pit: Distance to nearest well-____________---------Distance from foundation--------------------Distance to nearest lot line-----__.., 0 Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth---------..-.----------------...- 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----------------------------------------------- Remodeling and/or repairing (describe):-_--___ r'f I t --------- -___ - _ . . ___................. ---------------------- ---------------------------I —-------- ------- ---------------- ----------------------- 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. (Signed) ------"---------------------------------------- ---------------(Owner and/or Contr ca fo`l, By:.--- - -- --- --- -- - -- --------------------------------------------------------------------••------...--------------------------{Title)---...-------------- --- - ---------------- -- ------------.. (Plat plan, owing size of lot, location of system in relation to wells, buildings,'etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -t-04)- DATE----- ` G REVIEWEDBY---------------------------------------------.-------------------- ------------------------------------------------•.......... DATE------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------ .....---...------------- DATE--------------------•------------------.:. Alterafions and/or recommendat ions:----------------------------- --------------------------------------------------------------------•----•------•---•-•------------------------•-•-- ---------------------------------- ---------------�---------------------------------------------•-------------------------------------------------------------------....------...------------------------•-----/.. a - ---------------------------------------- ------ FINAL INSPECTION BY:............G._.------ - Date / !_.. - _.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,caiifor�w, ES 9 REVISED 6-59 gM 8-61 ATLAS