14626 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..... ............ ----------- ----------------- --------- --------- --------------------------------------- ------ (Complete in Duplicate) b r 3 Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued f30_011 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. W' Or 99 ®N 9egjV%P47 YV -WOO)/ lve/. 2 Z2`7 C_ nJ , a�-t.4 Y_ �O 1 'RT. O�v /ry fj#1 T� 7*1 1�c�.v 56e 0, JOB ADDRESS AND LOCATION 7T--2----,3QX_4-e+T--------fm1 -•---------t.�j.y'...40.......r.1.CaQ9'.l-------------------------------- 3 Owner's Name..----G,..A----//_-.rEw-.99------------------------------------------------------------------------------------------------------- Phone.E/�!_• - Address-----.......-----C s ? �. .....•--•------------1-1--------------------•------------------------------------------------------..-------.--....................................•------..•-.. Contractor s Name.. r1`�r :__ ��Le� Iz!. .t iP JA.-2.0---------------------------------------•-•--•---- Phone �a9 lrJ.7 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y Number of living units: .../____ Number of bedrooms _j--- Number of baths .1_4 Lot size ---A471----- .....- C....................... Water Supply: Public system ❑ Community-system ❑ Private g Depth to Water Table .------- ft. Character of soil to a depth of 3 feet: I.Sand ❑ Gravel [jSandy Loam Clay Loam [IClay❑ Adobe❑ Hardpan ❑ Previous Application Made: (1f yes,date____________________) No a' New Construction: Yes ❑ No Fj-_'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ----- Septic Tank: Distance from nearest well-----------------Distance from foundation____----____._...__-Material-________-________-------------------•-_._...... 's. ❑ CYISTI#4 No. of compartments-------------------•------Size--•----•------•-------•--------Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well___/.��.._.Distance from foundation__��...._.___Distance to nearest lot line.,�'t'-__._ Number of lines------1___-.-- - Length of each line------Ti.0----------------Width of trench--- 5 ...---------••-_---- Type of filter materiaG Depth of filter material____ -------.--Total length----- ___________________ /�ry/� t Seepage Pit:" "" Distance to nearest well- _________Distance from foundation to nearest lot line..t-Q...... Number of pits------ ------------Lining material... _Ck.__-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):_______-OV.-:e�------ -7�-- ---- --------•`rr --------------------------------------------- - - ••------•-------------------•------•-----•-------------•-•--•--•----------------•------------•-•-----.....-•-----------------•-••----------..-------....._._-_---------•--------...--------------------------------.---- -------------------.----------------------------------------------------•---..............----------------•--------------------------------------------------- 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. ry (Signed)------.... 'e-V' Y-° --------------------------------------------------.....(Owner and/or Contractor) tBy:---....... --•------- --------•--•--------- ---------------(Title}---. (Plot plan, showing size of lot, locetion'of system in relation to wells, buildings, etc., can be placed on reverse side). .. FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY - `------------------------------- DATE I! REVIEWED BY---------------------- -------------------- DATE - --- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations.........----------------------------- -------------------------------------------=---------.-. -----------•---------- --•--...--------•---.-_---------..... --------••--------------------•------------------- . x ..............................................._.--. --•---•---••--------- ------------------------------------------- ---------•--- I -•---------••-------•-----------------------•-----------•--------------•-----------..... - . . FINAL INSPECTION• BY:. Date_- -f`/a_`6-).----------- - --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California -Lodi,California Manteca,California Tracy,California ES 9 REV{s Eo 5-59 2M 0-61 ATLAS