14893 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ---------------------------------------------------- APPLICAT16N FOR SANITATION PERMIT Permit No. ------- -------------------------------------------------- � -------- ------------- ----------------------- --------- (Complete in Duplicate) -Z— Application Issued __ _1__..._.. .__________________________-------________-------------- This Permit Expires 1 Year From Date Issued ��(,, D Application is hereby made to the San Joaquin Local Health District for a permit to construct and Ing, the�whL✓ C here described. This application is made in compliance with County Ordinance No. 549. 0MON 1��14 N T�C��" 1 tOB ADDRESS A D LOCATION-- Q----5f-PE'--- --- 4J�; • - V�------V--l�-----QF--•---- ------- + -----•-••---- Owner's Name �, _�: I 'AEN-T_,��h SC-1 n Phone ' nn --'--- Address-----... 1_ .-n ------� �_LR- . ...__.._._11 --TFK�------------------------------------------••---•--•..................... Contractor's Name•_�O' T•J -CA------ 3E •--•----- Phone....---....- ----•••... Installation will serve: Residence n Apartment H use ❑ Commercial Trailer Court ❑ Motel ❑ Other �,�f-1 �>�.. + Number of living uni s umber f bedrooms ___.____ Num er of afhs ________ o s e .___.. ________________________________________ Water Supply: Public system ❑ Community system ❑ Private.0-IDepth To Water Table &7-ftg Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [ Previous Application Made: (if yes,date.......... } No [A New Construction: Yes ENo ❑ FHA/VA: Yes ❑ No Fl--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well_-10 _._Distance from foundation---,14 _____---.Mate al___ _l _ ET _--____. - Size__2�_ __ -_- __ capacity----7 - ' No. of compartments_..______ _.__.___ __ -__.� �__.___Liquid depth-...�_�_ .._-__ _ ._ . Disposal ield: Distance from nearest well -_fO_0_Distance from foundation..... .......Distance to nearest lot line___- Number oflanes___-•__-_-r.�_____________________LiingtA of each �____--Width of trench---------- ��__.__._..... , Type of filter material._. Q _ ._Depth of filter material_______I�'_f f._Total length________ 4 crJ_ _____________ E Seepage it: Distance to nearest well_____ ___Distance from foundation.,,../0--------Distance to nearest lot line----- Number of pits--------J------------Lining material../3 Size: Diameter.__�'ZgX39Depth-_-_---f 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---------------------------------------------------------------............----------•--------------------------------------- Remodeling and/or repairing (describe) --------------- -••iI--...•--•_.....--•••-......----•-...................................................... -----------------•--------•----------------------------------•-•------•------------------------------------------------'------------------------------------------------•--------------------------------------------------- -----------------••-----------------------•-----------------------------•-•---- -----------------•-------------------- ----------------•-••--------•-•----------•-•---• ..__._...._....------------r .i -- -----------------------.....................--------------.------------------- I hereby cert#y that I have prepared this application and that the�worl: will be done in accordance with San Joaquin County ordinances, St law and rules-,and re ulations of the San Joaquin Local Health District. '- .CG i - (Si ned 9 )•.... ..............................•-•----•- --•--•- -- ----��t� ---------•-----------------------------------------------•-••--'-Owner and/or Contractor). By:--------------------------------------- •------------------•--•----•-------f-----•--------------- ---Y•------------------------(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 -----______----------_?.-_._-._________________ -------------------- DATE-------✓-V----9-'--_6-fes' ---------- - REVIEWEDBY--------------------------------------- j-------'----------------------------------------------- DATE---------------•----------------------------------------- BUILDING PERMIT ISSUED--------------••------------------------------ +----------------------- •------••-------------------- DATE------------------------------ ----------------------------- Alterations and/or recommend'ations:---------------------------------------------------------------------------------_--•----.........------------------------------------------------------ --------- •-----------....-•-----•---------•------------- •- --------• ------------1 - -- ------------- --------•------------•------------ --------------------- •---• -• —-------------------------------- = ----- --- - ----------•----•- - -•---------------------------------- -- ..........------------------------------------- -••------------•--- _____________________________________........ t.... _ .-.-_ + 1--------------------------------------------------------- --- . .............k ... ..___ _._._. ______a____-_._...________._.._.-......--_._-.- _ FINAL INSPECTlO �'c 1t ...- _ wt._ �I Date......--- _72 ------------------------------------------------ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street '305 West 9th Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 EM 5.62 ATLAS f