15353 (2) - Laserfiche WebLink

Home Browse Search

! . ... 5_. _ ---._--__.- APPLICATION -FOR' 'SANITATION PERMIT Permit No. .__.__ __ -------------------------------------- --------------- (Complete in Duplicate) --------------- This Permit Expires f Year From Date Issued Date issued ..{....... .f Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. t' . : . JOB ADDRESS AND LOCATION_44T __ 1 --------------------- -------------------------------------------------- = •------•-------•-•----•---•------------------------ Owner's Name---- --- -------- - --.� --------------- -• ----- •-------------------- ------------••------------------------------- Phone_.................................. Address------f/3.2.... r Contractor's Name-____---- T� ----------------------------------------------- Phone....................,.............. Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ —_ Number of bedrooms --I--- Number of baths .o�.�.. Lot size _--- �J--f.7-7,& j. ............. i Water Supply: Publics stem � y [Community system ❑ Private ❑ Depth ro Water Table g�pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 21r Hardpan D Previous Application Made: (if yes,date--------------- No e New Construction: Yes Lr' No ❑ FHA/VA: Yes ❑ No f�t` TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.). Septic Tank: �, Distance from nearest well- ------Distance from foundation- AP.............Material_. _ -------- ----- p (`>C �7 No. of compartments -�'S__.:---_-._._. . _ Liquid depth----------- --------Capacity-- : Dispos Field: Distance from nearest well..A -Distance from foundationYA.............. r.7� Distance to nearest lot lines ___..... Number of lines----__-__----------------------Length of each line....lA-f____---_----_---.Width of trench----rZ¢_g. Type of filter materiaL�r[_f_14-----------Depth of filter material---h _�f----------Total length__ 4$p_`----------------- -- - -- Seepage Pit: Distance to nearest well------— from foundation-.Ylp_____._.Distance to nearest I t line---Jr-__/..._.. I-INumber of its- - --.__-___Linin materiahOC� ____ Size: Diameter__ -` p Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material -__.-.---_.---------_--_..-----___. d ❑ Size: Diameter----------------- ---------=---------Depth--------------------------------•-------------------Liquid Capacity q •------•--------------------gals. Privy: Distance from nearest well-------------------------------- -----------------Distance from nearest building------------------------------------------ [� Distance to nearest lot line----------------------------.-----------------------------_ - ' Remodeling and/or repairing (describe):------------------- ------------- ------------------•---.-..•---------------------------------------••---- --------- ...--•--------•---•----•-------------------------------•--•---•-----•--••-•---•--------------....-------------•----------•----•---•---------------------•-••---------•-----------•-----•---•---------- •------------------- . -------•--------------•---•-----•---------•--•-----•--•-------••---..._....-------...-----------------•----•--•-•--------------------•----------------=---------------•-----•------------------------------------- ------------------------------••-•------------•-------------•...----------------------------•--------------••-....-----------------------------------------------•----••---••------------•------------------------- - I hereby certify that I have prepared this applic ion a d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o e S n J/qu, Local Health District. (51 ned �9 )-------------• •-------------------------------...-------------------- - - --------- ---------------------------------- •--------------------(Owner and/or Contractor)By:------------------------------------------------•- - --- ------ - -------------- �----- ---------------------(Title)--------------------------------------- ------ ---------------- (Plot plan, shaving size of lot, location of sys In relation tobuil�'ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. __ ..............._ -------- DATE_____,!__ -1 — REVIEWED6Y -------------------------------------------------........ DATE--------- -------------------------------------------------- BUILDING PERMIT ISSUED-------------- ---- DATE-�------------------•--- - Alterations and/or recomm dations.__._--- _ -----...- c «l.-• -- ___-.- " C /__-••-- -3rr ti--------••---:•. / - ----------- - '�......... =- 7------------4/c------------------------------------------- -------------- ------------••----•------------------ - -----------------• - ------ -------;=--------------------------------------------------------------•-----------------------------------------------------...------------------- --------------------------------- ------•-••------- --------------------- FINALr INSPECTION .BY:. Gtr- Data....-,,—r^--------- --` a - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weil Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS