15235 - Laserfiche WebLink

Home Browse Search

FOR OFFICf US / - ._ ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit -------------------------- --------------- -------- (Complete in Duplicate) J ,1 ----------------- This Permit Expires 1 YE 3r 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 appplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. .._417cr�_.G= Owner's Name 1V G s ------------------------ -------------------------------------------- Phone-ae?171fY....... Address1� 1• ......... SfI?0�S' - --------•-------•----------------------•-----------------------...---------------------------------------------- Contractor's Name.......... -_1 �=j_ .s$'0 `5-----�/✓57------------------------------------------------ Phone.,// _ 4?• Installation will serve. Residence E]" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _:.1-- Number of bedrooms .-I/- Number of baths __R�n Lot size .--2_-_ 2. 5-.__-•................. Water Supply: Public system ❑ Community system ❑ Private [3'Depth TO Water Table 6_sa ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q _Clay ❑ Adobe ET/ Hardpan ❑ Previous Application Made: (If yes,date----- -----) No Q� New Construction: Yes ❑ No ff" FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----_.------_---Distance from foundation----------------- ❑ f'y �"'d' No. of compartments--------------------------Size-------------------------------Liquid depth--------------- ----------Capacity.....-----------_-_-- Disposal Field: Distance from nearest well.---.5_�7'__Distance from foundation....1..Q-'-----.Distance to nearest lot Eine..._4:-...... Number of lines............Z-----------------Length of each line-_--_—IzY ---------------Width of trench--------�Z_`t/-------------... czaod Type of filter mate -------Depth of filter material-----Z_e-----------Total length-........... _Q_-----_.--.-.•.__ Seepage Pit: Distance to nearest well----._---------------Distance from foundation.-------------------Distance to nearest lot line--.-_.------_- ❑ Number of pits---------•------------Lining material-----------------------Size: Diameter-----------------------Depth-------.---------------__.------- ' Cesspool: Distance from nearest well-----------------Distance from foundation--_----------------Lining material-----------------------.------__----- ❑ Size: Diameter--------------------------------------De th---------------- p -----------------------------------Liquid Capacity-------...--•--------------.gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building-------------------------.-_-------------. ❑ Distance to nearest lot line Remodeling and/or repairing (describe:---_.-o�_ --_--._-7 -.._--C' _______ 'YEj __________________ -----••------------------ -•--------•---••---------------•-----------------------------------.------------------------------•--------------•---------•------•-----------••------------------------------------•----------•- •------------------------ --•--------------------------• -----------------------------------------------------------------------------------------------------------------------•---------------------------•--------------..-------------------- ------.---.-------------------------------------- ------------------------------------------------------------------------------------------------------------------------------•-------------------------------------- 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)---- 1------a^ ----------------------------------- -----(,Owner and/or Contractor) By: .... � - - -------------------------------------------•------- (rtle)------ --_----------------......_-------------- (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). +, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _ "v DATE-----I-•-�...4__ - - REVIEWEDBY ----------------------------------------------••------- DATE----------------------------------- BUILDING PERMIT ISSUED------------------------------------ ----------------- -------------------------------- DATE-------------- Alterations and/or recomm nd'at- ns:------------- ------ -_..- }o f - - ----•-- --•- -9, ---- / .1C�--.... ti ----- - ----- ---- ------ --- -- ------- - --6-3------•------X�----�-- - �{ �b---era. .-__-:�_ ------------------------_••------------------ -- ----------------------------------------------- ---------------------------- --•-------------------------------•----------------------------------- ••------------------ FINAL INSPECTION BY:.... -- _- ---Q (,3 V- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srrset 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-52 ATLAS