14463 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------------- __----------------------------------____--___--____-__- APPLICATION FOR SANITATION PERMIT Permit No. ....f�, . ------ ------1-------------- --------------------------- (Complete in Duplicate) 7 (Z- ©� _ -------------------------------------------------------_ This Permit Expires 11 Year From,Date Issued d f Date issued ---V2---o 7 t Application is hereby made to the San Joaquin Local Health District fora permit to constructand install the work`herein described. This appp lication is made.in compliance with County Ordinance No. S49. _'d - 4.- .4m4.t— 106 ADDRESS A D OCATION 0, )D r Owners Name.--.n - - . -- : _ . -G tr r -----------=__ - - -" ` •tel -A lone. � Address............ �� -•-------- ------- • 1 c Contractor's Name----- ---- - ------ --- --- � ----- - - - ---- ' --------------------- Phone................................... R Installation will serve: Residence ❑ y.Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ i Number of living units: 6.. Number of bedrooms ...T. Number of baths .&__. Lot size __.._____^........... ....... ..............______ Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E].-Clay Loam ❑ Clay 0 Adobe❑ -Hardpan t "_P►evious'A" licatiori Made: if es,date------------------ - 1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -� _________________ ___________________.Material--------------------------------------------.. Septic Tank: ? Distance from nearest wellDistance from foundation ••• ❑ No. of compartments--------------------------- Size-----•-•----•-•------------•f--_Liquid depth---------------------------Capacity..............-_....... t Disposal Field: Distance from nearest well------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of lines__'_ ____________________________Length of each line-----------------------------.Width of french----------------------------------- Type of filter material-__---------------------Depth of filter material.......................Total length...................................... ` See a Pit: Distance to nearest well_-_/_-0,0-------Distance from foundation-----1__0....__.Distance to nearest lomat line__ �s_�__._e_� Number of pits___1....1..--------Lining material.. Er__-.Size: Diameter__-__- ----------Depth____ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..._-__________________-_____________ �Q Sixe: Diameter:__- -------------------------------Depth----------------------------------------------------Liquid Capacity..----------•------••---.:..gals. Priv`y:� Distance from nearest well--------------".--------------------- ----------Distance from nearest building____________________________-__-_______- ❑' Distance to nearest lot line-- ---------------------------------- --------------------•--------- •----------•----- repairin€g (describe):-------- ---------I tiara---------_------------------------------------------••---••---•------------------- l r c -----••-----••-------•-------------------------------------------------------------------------------------------------------------------------------------------1------ hereby certify that I have prepared this application and that+he work will`be done in accordance with San Joaquin County ordinances, State laws, and rules and.regulations of the San Joaquin Local Health District. ----_----•- --- (Signed) /or Contractor) r --------- - ------- Br -------------'-------------•---------••---- (Title) ... Y•----•--•---• - .___ ------------ - (Plot plan, showing size of lot, location of system in rely ' to wells; buildings, etc., can be placed on reverse side). i ^, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ABY____ ---------...---------------------------- DATE__-2.-f . REVIEWEDBY---=-------------------r---------------------------------- ----------------------------------E----------_-_---------------- DATE..................... --------------- . BUILDING PERMIT ISSUED--------------------------- ---------------------------------------- ..........................--- DATE---------------------•-------------------------------------- Alterations and/or recommendations•- �'--- ------------------- = } f .!. ' € ..:................•--•----•-----•----•-------••. ------------- ----•-------------------- } 1 ----- �. • -- -- ------------------------------------------------------------•------------ FINAL INSPECTION BY:- ..-.. -- -- - -- � ..� ------------------------------- ate----------------��------------ ----- •- - i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street � e 124 Sycamore Street 205 West 9th Strut i Stockton,California t Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-49 21A 6-61 ATLAS K