15069 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- -------------------- -------- SE---------------------------------------------------------- / ------------------ -------------------------------------- APPLICATION raj TANITATION PERMIT Permit No. ---------- -------------------------------------- (Complete in Duplicate) _------------------------------------------------------- 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 ap lication is made in compliance with County Ordinance No. 549. E JOS ADDRESS AND -OCATION . � _._ ... _ Owner's Name. .0 t ------- --------- _ ---- ---- - ------------------------ Phone--------- ----•-................. Address------- ---- ----- " ...................... A .. .--------U-•1---------- ----------- ,. t Contrec+or's Name '''" ------ ter- -_--=-.�_..__ Phone................................... Installation will serve: Residence❑ Apartm + House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ - Number of living units: ________ Number of bedrooms ________ Number f baths _�__ Lot size __. _____ _�_.�'� .................. /Water Supply: Public system ❑ Community system .❑ Private Depth TO Water TableQ_,y,q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2KE'iay Loam�V% lay ❑ Adobe❑ Hardpan [I`Previous Application Made: (if yes,date._.---- ---) No El New Construction: Yes ❑ FHA/VA: Yes ❑ No ' TYPE OF INSTALLATION AND SPECIFICATIONS: _. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic nk: Distance from nearest well-----;5A----Distance from foy,lndatin-----f G________-Material_____:'-------- - - ?c... < ... No. of compartments----------2...........Size_ l ____ _ '___. _. _tiquid depth___�__f-------------Capacity__j-2-0_... ... Dispos Field: Distance from nearest well------ ..._.Distance from foundation----��___'----:Distance to nearest lot line_S .. I Number of lines_._.________----------- _. Length of each line----1rlrt_f�'._f__ __._----Width of trench---,�_�__{___________________ -� Type of filter ma+erial..._ ....Depth of filter material.._-.__ _`�-.-_Total length......f.4_0......................... Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----____-_-.___-- ; ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------.___.....Depth_______.---_-------•______--_---- , Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- Size: Diameter--------------------- - ----..De th-----------------------------------------------------Li Ca aci i I ❑ - ------ - p uid q p tY•---•--...--•---•-------....gals.� t Privy: Distance from nearest well---------------------------_-------_-----____----Distance from nearest building._______________________-_________._____- ❑ Distance to nearest lot line--------------------------------- ------------------------------------- -------------------------•----••-----•--------------••---------------- 1 Remodeling and/or repairing (describe):--------- -------------•----_--- -------------------------------------------------------------- ...................................................... -------------------•---------------------------...---_._...-------------------•---------------------------------------------------------------•---------------------------•--•-----•------------------------------ I hereby certify + t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I sf,Iand rules and regulations of the San Joaquin Local Health District. (Signed) - ------------- ( dor Contras+or) -- -------------------------------------------------------- _�-.. BY - Y?r�• =:— f -- _ (Title)------------- --' '. ..._.._' --------- em - (Plot plan, showing size of lot, location of sys+em i, relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATE-_IL 3" ----------------------------- REVIEWEDBY------------------------ --------------------------------------------------------------- ---- DATE --------•------------ BUILDING PERMIT ISSUED....--••--•------•------ --- ---- --------------------------_------------------------------------ DATE--------------------------------------------- ------ Alterations and/or recommendations:----------------------------------------------------------------------------------- ------------------------------------------------ --------- ......................•-----•----•- ------------------------------------------------•---------------------------------------------------••---•-----._.........._.....---••--•-•-•----......... ........................ --••-•--•----••-•-----•----•-------------------- ------------•--•------------------- --------------------- ------------------------------------------------------------------•-•----------- --------------------------------- ------------------------------- INSPECTION BY- - . - ------ Date--_44- 1-7-G- y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street .300 Wesl-Clak-Striet• 144 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a•59 ZM 5-62 ATLAS ' - �E