14822 - Laserfiche WebLink

Home Browse Search

kLL irl: USV. AQfie t/ 10 ; ` APPLICATION FOR SANITATION PERMIT Permit No. .. . ............. -_-�.1--------------------------- (Complete in Duplicate) z� _______________ _________________________________________ 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. J08 ADDRESS AND LOCATION .. --- -- 4. .....................1� - Owner's Name------ - 4 _ 7-alkoww_---------------------- -----. ----------:: ----------------------------•-• Phone------ .................................... ----•--- Address---------------- �. CoIti- Contractor's Name__ _.f� ............. .. • _ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __! ber of bedrooms _._Number of baths ../__ Lot size ___ C.-__-..y------�... - ...--....... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table """Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date_----_._-- ------) No ❑ New Construction: Yes ❑ No [�rFHA/VA: Yes ❑ No ❑ ° s� T TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tkT R Distancefrom.nearest well------------_____Distance from foundation-------------_......Material---------------_---------I............�......... , # No. of compartments:. r-...Size Liquid depth.....- = Capacity. i wa / D' osa) 'Ald: Distance from nearest well.t�S, A.ff._Distance from foundation...._!..............Distance to nearest lot line._..: �l' Number of lines.:...... ____ _______ _ Length of each line...... _ie�_.____.Width of trench..__.. _ .`..f.-_-_.__. 0 T-' __ 44 d Type•of filter material. _ _ _Depth of filter material___ _ ____________Total length____......_._______.__..__. _ � p ge ,ii Distance to neareI well-1*l KA---_-_Distance from foundation_.- ./.--.Distance to nearest lot line__ . } Number,�of pits'-- --:--'--•--.-_LEnmg ma#anal-- .V.� `------Sze: Diameter__._.-. -. -:-__-_.Depth-----: -- -----•---_-.... t + , Cesspool: + Distance from nearest well_________________Distance from foundation___________....-,_.Lining material-----------------.______.___.______-- m ❑ Size: Diameter--------------------------------------Depth--•-------------------------------------:-----------Liquid Capacity-------------_------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__._______________-------....______-__'., ❑ Distance to.nearest lot line-------------'7--`R--------------------------•--------------------------------------------------•--------------------•----------..-------- Remodeling and/of repairingf(descnbe):.-- ...---�------------------- = -.- -----------------....................... •s . .I.....-- ------ ---------- `^ `k a ...-•-•--------•--•--.:_---V.1...------ ------------------------- ...•- - ---- -- - ------ .___ .{-a`T"."'?`;•-` —a„` ••....... .....:.:..»-..,.------------.•------.--------------------------T----•-----'•- --------------------- ----------------•----- 1.................. -----.•------------------------ I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin County l ordinances, State'laws, and rules and regulations of the San Joaquin Local Health District. ...... (off ) Si ned � � •-.�--t-� V�-�--t--- ••---------------•-------------•-------•--------- �er-Contractor _ --q- ---- (Plot - Title ------------- -------- -------------- By:_ « ---------------••---------• •• -�-- -- -- - ( 1 (Plot plan, showing size of-lot, location of system in relatio o wells, buildings, eff.., can be placed on reverse side). i, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_��__- r ' ----------------•-------------------------------------- DATE �rl ----;------------- REVIEWEDBY------------------------------------------- --------- -----•---------------------------------------- DATE----------------------------------------------.............. BUILDINGPERMIT ISSUED------------------------------------------------------------•---------•----------------------------- DXTE-------------------------------- ---------------------_--•- Alterationsand/or recommendations--------------------------------------- •-------------------------------•-•--------•-••--------------------------------•---------------------------•-_--------- --._-----•-------------•--.....----•-•-•-----------------------.._.._...... 4 .......................................................... ---------------------------------..--..--------------------------------------------------------------------------------.-------.._---------------------------------.----.------------------------------------------- ..-. FINAL INSPECTION BY:/V. .. _ - _ Date__ .I_ /-6--------- ------- -- SAN ----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT t �r 130 South American Street 300 Wed 0".Oak Street � e '124 Sycamore Street 205 wast 9Th Street Stockton,California Lodi,Californias-1 Manteca,California Tracy,California CS, 9 REVISED 8-59 2M 5-951 ATLAS j j 1