14528 - Laserfiche WebLink

Home Browse Search

f FOR OFFICE USE: , (-- -------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) .---_-. , Date Issued -/..• --- � C 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 compliarice with County Ordinance No. 549. JOB ADDRESS AN , •--....1 �� -- -•-•-------- - --------------------------------------•-----•-----•-------------------------------Z � r Owner's Name----- ----- 4 -- Phone ........... Address _ --•-•----- -•----•------------------------------------------------------------- ------------------ - Contractor's Name--=------------- ' ...------- :�� ._..---------•-----=----=---------------------...-------------------.----------------- ---. Phone..........-_........................ Installation will,serve: Residence` i Apatrtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other;❑ Number of livingunits: ._' .--_ Numbegqr of bedrooms -.__...Number of�baths _.. ___ Lot size ....---..._�_.y_--.__i.`__........................_.._ r i 1 . .. . :. i- +�+--��- - .-- ..ter".r"'-... Water ,.'. - .. 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❑ , Hardpan ❑ Previous Application Made: (If yes -------------------- No ❑ New Construction: Yes ❑ No ❑ - FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool=permi#ed if public sewer is available withiW200 feet.) I IN Septic Tank: Distance from nearest well--'A/47tfi___Disfance�from�oundation:::::f0-:-::._-.Material-. 'e a:...... ......... ... No-of compartments--j---,.-_.-Z-_----Size___9-_x __ 4..15._--Liquid depth------- ------------Capacity. - Disposal Field: Distance from nearest well-_A94!4.D ista ncefrom foundation ---.�..-... .Distance to nearest lot li 6................. . . Number of lines.. 4............__-Length of each lineal.;.31 31�2 i -Width of trench--------- 7 -.---71----- .".Type _ -- ,.:Type of filter maferial-i. :��epth of filter material........ _Total length- -!6�___.�------------- [ �, w Seepage Pit: Distance to nearestwell----------------------Distance from foundation-_-__I_._...--....Distance to nearest lot line---------.-----.- ❑ Number of pits._'---- '----------Lining material----------------------Size: Dia meter-------_--------------.Depth.---...._......_...._......._.._. f 1 = Cesspool: Distance from Inearest.well-----------------Distance from foundation---'- ---......_-:Liningrrrteriel----------------------------._-.-...- Size: Diameter=---..----_-`--_- f [I , . --------------------Depth-----------------------------------------------------Liquid Capacity.............-..............gals. Privy: t Distance from nearest well------------------ -----------------------------Distance from nearest building------------.._-__----. ------..--.-----. - Distance to nearest lot line----------------------------- ! Remodeling and/or. repairing (describe)y' ----- ------------------------ `-....................................... --•----•----••---•-----•--•-----•-----•...-----•--•---------------------�•-------................--•----------1----------------•---------------•------------------=--•--•--=---•- ----------------------•--•-•-••-------- -----------------------••-•-----------------------•--------::...-.-- ---••••••-•------•----•-......---=-------- --------------•..-•---•-------•----•--•-----------•-------------------- } r ---------------------- 1........ YY F,,: ordinances, State certify, lewsh andat I hulesave Pand regularonared this s of the San Joaquication and that in L cal Health e work will eDdone sot�c+n accordance with San Joaquin County (Signed)._---�-�I/ --- -------__ -- ...... .......-•...I. ----., ---- ----- ----.-(Owner and/or Contractorl r (Plot plan, showing `size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i. > FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - ------ DATE----___ter_Z6--- --'-- REVIEWED-BY------------------------------• ------------------------�----•--•----•••-•-------....._...... DATE-------- - BUILDINGPERMIT ISSUED----------------------------------------------- ---------------...................................... DATE ---..------------------- ----------------•---- _- . Alterations and/or recommend'ations�........ ....... ............. -------------------......---_,-----------_-------=---==-.__----:.....---....----_..----•--••--------...--••----------•-•--....:..--- f ---- -- ------r .......... -P - ---- = ------lw_vr -------- -- .` ---------- I /�� FINAL- INSPECTION BY:..-�-"-•--f--�- - --•--..-�`-�.�r---------------- Date---�------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I - 130 South American Street 300 Weil Oak Street 124 Sycamore Street 405 Weil 9th Street 1 _. Stockton,California Lodi,California Mont"o,California Tracy,California ES 9 REVISED 8.59 PM 8-61 ATLAS