16321 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: . ----..---]------ ��r` 3 APPLICATION FOR SANITATION PERMIT Permit No. .................... - ; ------ I ----------------------------------------- (Complete in Duplicate) c' lc'3 ------------- ----- [ This Permit Expires 1 Year From Date Issued Date Issued .5-t- =_--- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--:......Y-3— --W.---•9�Yi--- -----x--------------------------- L .t - r Owner's Name---------... Z ria.-... ,a_r_a--Juare�G----••-------------------------------------------------------------------------------- Phone__HQ ----3."334>'--. X36- W -gth__s -----------------------------------------------.---------- ---- ------------ Address-----•--------- ------ ---------- --------------------------------------•--•----.......--•---=------------------------.._-.....---------------- Delta `Se tic Tank Serv. , Inc. ' Phone---Contractors Name----------------------------------- ------------•-------•----------------•---------•- t Installation will serve: Residence:K]J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-I--- Number of bedrooms -----2 Number of baths .-.1- Lot size ------5.a...x--2-5.Q---------------------,--------- Water Supply: Public system [ Z Community system ❑ Private ❑ Depth To Water Table --3!i ft. 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 EX New Construction: Yes ® No ❑ FHA/VA. Yes ❑ No Ea TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) F -- Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----------------------_----_----------------. Exi(qing No. of compartments--------------------------Size---.----------------------------Liquid depth--------------------------Capacity--------•-------•------ Disposal Field: Distance from nearest well--------------_-Distance from foundation--------------------Distance to nearest lot line................. ExidUingNumber of lines-----------------------------------Length of each line-----------------------.------Width of trench.--------------------------.------- S. Type of filter material------------------_-----Depth of filter material-----------------------Total length-----------.----.-..---------------------- W Seepage Pit: Distance to nearest well---------nd-------Distance from foundation....1-01------.Distance to nearest lot line.... -------- 6 [� Number of pits.------1----------Lining material..-X0.0k------Size: Diameter----33"............Depth--2-51-M ax--------.--- C Cesspool: Distance from nearest well-------------_.-Distance from foundation--------------------Lining material--..-------..--._-------------------- G ❑ Size: Diameter.- '----------------------------------Depth----------------------------------------------•-_-Liquid Capacity..--------------------------gals. IP Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ I ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------.......---------------- Remodeling -- ------Remodeling and/or repairing (describe):--------Adding---,',,-3-ix2,�-r- t..._Y.ilt-er-!B1Bd---to.___ex _s_t1ng___.ay.ateM....... ----------------------------------------------------•------------------------------------------------ -----------------------------------------------------------------•-------------------------------------------- ---------------........-------------------------------------•-•----------------------------------------------------------- ---------•-----------------------•---------------------••---•-------------------------------- -I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed)------------ ella--3et- c Tank Sere. z ---------------------------------- ------------------------(Owner and/or Contractorl By: Pe '�Y-- Qarthn.. -----------------•-----------= (Ti+lel Pres_._._.Gen,.--Mgr.... . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t F DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------ ' - ---------------------•-----.----- DATE------------•-- - .--... I ,! • =. REVIEWEDBY------------------------------------ -------- -------------------- ----•----------------------------------------------------- DATE-------------------•---•--•----------------------------•--- BUILDINGPERMIT ISSUED-------------- •------------------------------------------------------------------------------------- DATE------••---------------------------------------------------- Alterations a , or recommendation • - - ---------------------------------------------------------------- ._...-. .- ---art --------••�'• --- --------------------------------------•-------.....-----------------..---------- i -•------------------------------------•------------..-.--.._-.....•----------------------------------------------------------------•--- i FINAL INSPECTION BY:- Date -------------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California :1 Lodi,California Manteca,California Tracy,California E5 9 REVISED a-59 2M 5-62 ATLAS