15228 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------- --------------------------------- Is-a'�� ------------------------ ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..............._....... ---------- ---------------------------- ----------------- (Complete in Duplicate) � - ______________ This Permit Expires 1 Year From Date Issued Date Issued .____ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �7 A A-IN 1=C-. d JOB ADDRESS A D LOCATION /11 .. � �Y _l_ 1 .x_I�?C� p�............... .Fto Owner's Name-- E:_.R.P4.04------- I = - -------------------------------- ------ Phone._.----------------__-_------ J_ Address----- `r ........4!.M ------------A .__ ' ?.. --------.cA-4f-"i.�---•-•---------------------•-----. 1�.dv C1q--...._ h' "? -----S—EM....---- ---------------- Contractor's Name__ _ Phone................................... Installation will serve: Residence ff"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..___ Number of bedrooms,='•rNumber of ba+M.—ALoilize ------A.Kx ± r- -••-•-•--•- y ; Water Supply: Public system Community system [-IPrivate Depth TO Water Table J,.�K_ ft. Character of soil to a depth ofP feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑1 Clay ❑ Adobe ❑ Hardpan ❑ r Previous Application Made: {If"yes,date--------------------} No [ New Construction: Yes 2;'O'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATrONS:� �+ (No septic tank or cesspool permitted if public sewer is available wifUn 200 feet.) Septic Tank: Distance fro m nearest well_________________Distance from foundation._______.._.._..__.Material___________.___...-_...._-.._-_...__.._______---. ST?N(a,- No. of compartments--------------------------Size---••-------- /------------Liquid depth---------------- -----•--Capacity--------•--•----•--.--- Disposal Field: Distancw frolm nearest well_________________Distance-f6m-foundatiori....................Distance to nearest lot line................. E_kff_�;j/ Number of,lines----..---_-----------------------Length of each line---------I---------------_-.Width of trench.---------:-----------------.------ J Type of 4iIter material-------------------------.bepth/of filter material-.!____----------.---Total length----------------------------------_--_--"_ Seepage Pit: Distance Jnearest well------6_$7___Distarice,from foundation_........ 0.--Djstanc tp nearest lot line__. Number1 f pits----------I----------Lining material---F6 C-X._...Size: Diameter__5__X__ ____Depth."--._/V____"______________ Cesspool: Distance fl m nearest wel�71 .______.�Uistance from foundation_... ___________.Lining material________________________________"-_._ ❑ � � If --- ----�--------- ---------------�"-- - ------------------Liquid Capacity-------.-------------------gals. Size: Diameter-------------------- ---- De th----•---------------- --- y: � a from nearest building---------------- _--_----------------- 411_ ----------------------- Privy: Distance o nearestlotl nl .D�s'tan -•-•---•------------_--------------------- �r.w. Remodeling and/or repairing Idescribe):-----------tl-------------------- ----------------�'--'-�"-----------•---.._.. ---------- ---•------- ----- Q -.. .. -----aAl Al. -•�- �.��'r�� fir l� ' A ------------------ ------- : ar this�applicatio�n and that the�- ------------�•-------------------•-• -------- �� --•-•------------------------------------- � ----------------------I-•---_----- I hereby certify that I have �1-epd or twill be done in accordance with San Joaquin County ordinances, State laws', and ales and r ulat�tO�ns of the San Joaquin Local Health District. � {Signed} -• -!--_ _------------_---------------_ . ��wner end/or Contractor) T 4 ------------- -----------------------------------------• ---- _ (Title)- ------------------- ------------- By:(Piot plan, showing size of lot, location of system in relation to wells, buildings,ie�tc., can be placed on reverse side). . -FQR DEPARTMENT USE ONLY ,. APPLICATION ACCEPTED BY!_____'1_t_ -� ` `- ---•-•--- DATE...... REVIEWEDBY------_--------------------'------------------------t--------------------------------------------------------------------. DATE----------------------------------------------------•------- BUILDING-PERMIT-ISSUED___ x A-E Alterations and/or recommendations:- -__ --_-- --------•--•------- -----------------•--------------------------_-- 4 w t .. ■t�� 4,_____________________________ _ _ __________ _______ _________ ____ __ __ __________________________________I.-.-__.________-____..._.____..-_._..________._-_----..___._______._..._._-______...____.__________-____________-.....___________•___-___.-______.._-_____________-_______._------.....___ _____________________________________ �._ v--___.__._ --- --_ .______.....______. __ _ ___________________________________"___.-_-_______.____..._____.____.____________..._____._.__________._______._.... -----------------------------___________________________________________________ �Z,- / FINAINSP _. -f Date-- ---------------------------- ----- ---- --------------••--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American_Stirset 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2M 5-62 ATLAS