15818 - Laserfiche WebLink

Home Browse Search

FO OFFICE USE: t ------��-1-��-- --��-- ----------------- 3-----_-------_% � APPLICATION FOR' SANITATION PERMIT Permit No. s_ -------------- ------------------------------------------ (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued ..../................ Application is hereby made to the San Joaquin Local Healfh District fV a permit to construct and install the work herein d crbed. This application is made in compliance with County Ordinance No. 5 �-Q�r,. >� JOB ADDRESS A LOCATIo ------- ,e�- .. Owner's Name... ' . --••-•--- • ----------•------- --•------------- = �-._. Phone.. Address------------------------•-••--------------------------..... = '!` Contractor's Name---- ------------------ Ali.,,,. -------------- I!.I.:........— ..........-.- .. "- ------...... Phone----------------------- .......... Installation will serve: Residence V--kpartment House ❑ Commercial ❑ Trailer! Court ❑ Motel [:1 Other ❑ pe I Number of living units: ___ Number of bedrooms . Number of baths __ .;Lot size _ ___ _ __ ___________ _____________________ Water Supply: t Public system ❑ Community system ❑ PrivateDepth To Waterjable,93. ft. Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam E3 Clay L� am ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made:-(If yes,date--------------------) No ❑ New Cdnstruction: Yes ❑ No ErIHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within'200 feet.) ti ank Distance from nearest well_________________Distance from foundation___1L.-I.....�Material------------------------------------------------- No. __-___--_._-_.-__-__-_ _•.---:--_____________-No. of compartments----•---•--------- -----Size-----•------------------.---i_..Liqui depfhb?.....-------------------Capacity................ Disposal Fie Distance from neares well-0------.-Distance from foundation • A.—...:�Distance to nearest lot line.�......... . Length of each line'_ �' Number of lines______ I� C/- Type { _ ®� � ----�-+------ g -�`r?:---;=- ;-----Width of trench.---•�---- --- Type of filter material.>.?�Q _pepth of filter material..___ __+-_Total length.............. s:...... ..._ ' P 9 fl � .. �- --fr .._._._.Di11. st n(;e to nearest,lot line...See a e Pit: Distance to nearest well__ _ _.__plstancedation_...Number of pits...-f_______________Lining materialSize:.Diameter_ �_-�__-_.Depth____42 --.__________-___ Cesspool: Distance from nearest well--------_--------Distance from foundation....... -------------Lining material-------------------------------------- ❑ Size:,Diameter-----------------------------=--------Depth-------------------------1------------ 1----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------_--------_--- Distance from nearest building--------------------------------.______._. ❑ Distance to nearest lot line----------------------------------------------- -------------•-•-- ------•---------------------------•------•-----.---------------------- ry Remodeling and/or repairing (describe): ---------------------------------------•------- ....................... ------------------------------------------------------•-------------------------•----•-------..........-•----. ....__..... �M-----------------------------------•.....................---•---- ------ -------------- €I -------••-------------•-------------------------------------•-------------= 1 hereby ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules an gulations of the San Joaquin Local Health Dis�frict. (Signed):- _-- t -_-- ---------------------s -_-- - - - Owner and/or Contractor) - --- - ------------- By:--- ----- --- '�� r+le ( I ,� (Piot plan, showing size of lot, location of system in relation to , buildings, etc., can be placed on reverse side). �h FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----/`"I�-------- - ----�'`�-------------------------------------------------- DATE-------` l=r---- ------------ ------ � REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------�M.. DATE----- ------------ •-----------•-------------------------- BUILDING PERMIT ISSUED------------------------------------------------------ -----------.__.----•-----------••--:---••�I DATE------- ---------- --•-- •---- Alterations and/or rrqcommend'ations:..__.__---��C' �� ------ ..... 1---f-`- --`~ --�--------------------------------------------------------------E�--------------------- - --------------------•-----•-•------------ ----- --....-•------•--------------------- I ---------------------------------------------------- iM FINAL INSPECTION BY:. <----- Z date ` a EN SAN JOAQUIN LOCAL HEALTH DISTRICT ,. I 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Californla Tracy,California E5 9 REVISED 8.59 2M 5-52 ATLAS ,,,JJJ