15498 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _Z - (Complete in Duplicate) Z � j 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. JOB ADDRESS AN LOCATION_f�r�.�'I11�.d .Rk,-, .___ �' Owner's Name----- `41t-•---;Ll-- ----------•------ ----------- ------ Phone.............----------•------_--- Address.......... ----------- --rr.Y �LC� Vis. j _ Contractor's Name .n,�.- �✓-rv -AU'" --------- :,�s:., Phone ............. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _)____ Number of bedrooms Number f baths __ ____ Lot size --------- __d // •• U --•.-•.•- Water Supply: Public system [I Community system El Private }Depth To Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0-""Hardpan Previous Application Made: (if yes,date____________________] No ❑ New Construction: Yes ❑ No ❑ 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--------------------Material-------------------------------............ ...... ❑ No, of compartments-------------•------------Size--------------------------------Liquid depth--------------------------Capacity---------•---•--------- Disposal Field: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. ❑ Number of lines--------------------- ------Length of each line-------------.---_----..-----.Width of trench.--------------------------------- Type of filter material-------------------------Depth of filter material------------------------Total length----------------------------------- Seeps a Pit: Distance to nearest well---1__t�__®_f____Distance from f undation__-_��_�....__.Distance to nearest lot line__.._-.__.__ Number of pits-------I-------------Lining material___ r _.Size: Diameter-------.3A__''__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-------------------.._..-..___.____--_-_. 0 Distance to nearest lot line-----------------------------------------------------------------------I-----------------------------------------------•---------------------- Remode*ing and/or repairing (describe):--------- ��' "'----------------------------------------------------.-------------------------------------------------------- -------•---••-•--•------ ----------- --•--------------------------------------------=-------------•-- --------- ------------•----- •-•---------------------------------------------------------------------------------- ) 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. - l� G> �".t. '`----------------------- ------------------------------------ ---- �{Swner end/or ContrectoeJ (Signed B......•--------- �-�-z s-=* a ...... -0r-- - -- ---- �-4� -------------------------(Title)--------------------------- --- ----------... ---- ----- -- (Plot 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-- f ---------------------------------------....... DATE_A_ _4__-(AA 3------------------------------ REVIEWEDBY------------------------------------------------------- ---------------------------------------------------------------------- DATE.............. •------- ------------•----------------------- BUILDINGPERMIT ISSUED-----------------------------•----------------------- ------—-------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------------------------- ------------••------------------•-------------------------------------___---------------------------------------- -------------------------------•---•--....-------••-•------•-•--------------------------------- ------------------------------------------ ---------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------•----------------------- -------------------------- - ------ ------------------------------------------...------------------------------------------------------------------------------------- FINAL INSPECTION BY----- -- ----------------- Date.... --`- _7-~� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Stmt 144 Sycamore Street 305 West 91h Strout Stockton,California Locil,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS