15497 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------ ------ ------------- --------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ../�f.. -------------------------------------------------------- (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. E r JOB ADDRESS A LOCATION_ `I S--N'14 4 �2- ' �"-•' "' �i -"'a-tom, �r Owner's Name.... _. ___._ � �-• -_----• - ----• ----.l-'--'-"------------------------ Phone.....•-----------------------•-•--- Address.------•-•-- --- ° lvG✓- ---- - -------- . Contractor's Name..---------- c � a --------- ------------------•----- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__ Number of bedrooms __Z Number of baths ____/_ Lot size ____________________________________________________________ Water Supply: Public system ❑ Community system ❑ 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--------------------1 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____•_______.._.......-.----------------- Seepage-'Pit: ___________-____Seepa it: Distance to nearest well---------lrf_Q___.... Distance from fp undation__....l.G_.__._....Distance to nearest lot ler Number of pits---------/-----------Lining material--✓ 1 .---Size: Diameter___-3A!--------Depth---l.Z...S .........I....... 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---------------------------------------------°---------------------- ------------------------•--------------------I-------------- Remodeling and/or repairing (describe): ------------------1---------- ----------------------•----- -----------------•------------------------------ ---------------------------•-----------------------........----•----------•-•---------•-•--------•---------------•-------.......---•-----•-••---•----•-•--------•------------........----------•-----•-•--------------------- ------------------------------------------------------11----------------------•--------------------------•----••---------------------•------------------------------•----------------•----- ----- hereby certify that I have prepared this application and that the work will be done in accordance_with San Joaquin County ordinances, St laws, and rules Ind regul ions of the San Joaquin Local Health District. (Signed)------ t.I- -•-- --- �Wellis. ---------------------- - ------------- and/or Contractor) ` ------(Title)------------------------------------------------- ---- --------- :----------------- -(Plot plan, showing size of lot, location of system in relation Idings, etc., can beplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_,5A -----------------__------------------------------------ DATE_.r�__79-!•-___G'�------------------------------- REVIEWEDBY-----------------------•------------------------------------------------------ - ------------------------------•------- DATE-------•--------•-----------------•----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------ --------------------------------------------------------------------------------------------•------••------------•-•-----•--•-------------- -----•-_- ------------------------------------------------------------------------------------------------------------------------------------------------.--------------------------------------------------------- ------- ----------------------------------- ---------------------------------•--...--•- -------------------------------------------------•-------------------------------------------------------------- ------------------------------------- ------------------------•------- ------------------------------------ FINAL INSPECTION - ------------------r--------- Date__ ..''? - �.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISER 6-59 2M 5-62 ATLAS i�