14400 - Laserfiche WebLink

Home Browse Search

FOR OFFICE X__. ",.v i � . ----- 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 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. /�.- --f�------------- ' JOB ADDRESS D,/LOCATION.. --- "-- --- -- ------------- -��-��A�-- ---- -. ��% •-- Owner's Name...... .. .. . .. �' - _ -•---••------------ Phone--_--------------------•------•------ ----•-�_ Address. = f -•'� � -L� _.� �!l -.lG�� [ --- ------ Contractor's Name------------ ---• ----- ---------- -------------------------------- -----------------............................ Phone..........--------------•-------•-- G Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ........ Number of bedrooms -------- Number of baths -------- Lot size _ � --- •••• tern Commuriit system ❑ Private Depth to Water Table ,C�. Water Supply: Public sys [I y y ( Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay❑ Adobe�ardpan C]Previous Application Made: (If yes,date--------------------) No New Construction: Yes o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) `` r 0 L Septic Tank: Distance from nearest well/5,0_____Distance tom foundationf_.��_:__.Mate>;ial____�--------------........................... I No. of compartments__-___ ____Size"� ' , -�-------- �4----------------------Liquid de�thf---- -------'�-.•-----Capacity:,__.// � l Q -- ,l6'40____-Distance to nearest lot line&.! --__- Disposal Field: Distance from Weare t well..�� ______.__Distance from foundation_ ._� Number of lines_...."__-._.-_- - Length of each line._/,Vf0""-__.__-��--.•.Width of trench.____��_ ..._____�__."_ � # Type of filter material-__ Depth_4�.��__ of filter material_____ --�-____.___Total length___________________ �...••___-"" om foundation . �-.Olsten a to nearest lot line_____.� i Yp ! terial_ ' """---Size: Diameter__�_1-a__....--"""Depth-R-6--------Pit: Distance to nearest well/40__,_t Distance Number of pits...... -------------Lining ma ; Cesspool: Distance from nearest well----------------_Distance from foundation--------------.__-_.Lining material---"----------._..____._..._.___...._ ElSize: Diameter-------- ------------------------Depth----"-----------•-----------------------------------Liquid Capacity--------_-_-------••--gals. Privy: Distance from nearest well-_-_-________----------------- ------Distance from nearest building.______-----________________---------"-"-. ---------------- ❑ Distance to nearest lot line------------------ --------------------- ---------------------------;-. ------"----/-.-y-A�-• ----•--••---- ......... t Remodeling and/or repairing (describe):____ C�"" �- --- �' �= ` --- 4............................ •-------------------------- ------------------------------------------- --- -------------------------------------------------------- ___________________________________________________ __ , I ......_________________________________"_ I hereb c ify that I have prepared his application and that the work will be done in accordance with San Joaquin County -. ordinancgs,, laws, and rules and re lations of the n Joaquin Local Health District. (Signed}___ ••-- - - •-- - - #ing Wer end/or Contractor} ...--•• --- _.._ ...BY� �.. . --------(rtle} ------------------------- -----------------�(Plot plan, showing size of lot, location of sys+em in relation t e Is, , etc., can be placed on reverse side]. FOR DEP 1 TMENT USE ONLY APPLICATION ACCEPTED BY------ .. -- --- ---- - ------ DATE--------- }` {o. REVIEWEDBY---------------------------- DATE-------_-- ------------------•--•------=------------ BUILDING PERMIT ISSUED---------=--------------------------- DATE------------•------------•- Alterations and/or recommendations:..-��,22-�0= -�-----1- - Y �}��-- �"""""""'-•'--"-------- -t --------••---------.- ••----....... IDate-------------- INSPECTION BY:.--------- + FINAL INS ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California 1 ES 9 REVISED 6.59 YM a-61 ATLAS