15316 - Laserfiche WebLink

Home Browse Search

FOR OFFICE SE: 3 ------- �� 7.6_x. "--lv.' d APPLICATION FOR SANITATION PERMIT Permit No. .,1��: --------------- -- --------------------------- ------ ,,�` (Complete in Duplicate) / --------------- -------- --------- ---------- -- 4 This Permit Exfres Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constructinstall h�work herein described. Thisa plication.is made in compliance with County Ordinance No. 549. 't l S�"5:. ._ /-r , JOB ADDRESS AND LOCAT ,E-------zw.n--------------------------------- Owner's Name------�,_�=-----��f-�.t`�-lf-�----------------------- - Address-•-- •--•-------• ', ' m � ------•--- ----------------- ---------------------••-----•-----------------------------_---------------- ----------------•-------••--•----------------- Contractor's Name. 'fes=A= �� 1 / /T� f l� V�C' � �G6_3P�[?7_ -------. Phone..- • •--- Installation will serve: Residence 2-__` partment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: ` ' ' ` �..__ Number of bedrooms _�-_ Number of ba+hs {l__._ Lot'size ._._.:��_.__._f�.p��-__----•--_"--_•_ Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table _ 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 [' New Construction: Yes ❑ No ®' FHA/VA: Yes ❑ No _r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)L -k Septic Tank: Distance from nearest well________________Distance from foundation____.___':..._____..Material__.___________.-___..__._.........._ ElNo. of compartments--------------------------Size-------------- --._..Liquid depth--------------------------Capacity Disposal F'el Distance from nearest well---�0--{-Distance from foundation_ -- __( Distance to nearest lot --� ,® Number of lines____ _______ __ _ Length of each line.______!.S_:"C?!---_--•"_.Width of french-------- " --- ------------ ,� ...--------� G Type of filter material__ _ "Q�_t�.__"-"Depth of filter material_.__• c5'_ '___-Total length'________________ Seepage Pik Distance to nearest welL �s ----""---Distance from foundation___--____.Distance to nearest lot line---�� Number of pits--------.--..______-Lining material__- Pi ..Size: Diameter_--- �' ..�,.�------Depth---._.._.�.5---------------- rom Cesspool: Distance Diameter nearest Well____ _•Distance from foundation__.________.---------------------Lining material_-_.-__-.__________-._____--___-_--.. ❑ Size: Diameter --------------Depth---------------------------.----- ---------------Liquid Capacity gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_________--".______--___...._ . I Distance to nearest lot line__________"._______________________ o + .. Remodeling and/or repairing (describe):.........��c -- "6---._�Xl -------•-=------------•------•---- ----•-------•--•-----•-----•-------------------------•---------•-----------------••----•-------••-----•--•------••---•-•------------------------•-----•--------------•-------•--••------••---------------•--------------:----- --••-- --••-----------------------------------------------•----•---------••---------•-------------- -------------------------------------- -----------•-------------------•----------------- I hereby certify that I have prepared this applica+ion 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. t (Signed)..---- 0- t- F 1 ------- ------- ------- -'---------------------(Own r and/or Contractor) BY:-------------- -l- `1- -- (Title) - ( ) (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). . • j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------�/------------ DATE_._ -_-'-- REVIEWEDBY------------------------------------ ----------------------------- --- DATE--------•-------•-- -- ----------------------------------••------- -- UILDING PERMIT ISSUED---------------- ------------------------ ---•------------._. DATE = -------------------------------- Alter tions and/or recom endations:- -. _1 1 - ------ ---- • ----------- ---- -- - ------------------•----#- ------- •-----• ------------- --• --------------------- ------ --- -------- ---_----.--------- -- -------"-------•----•--------------------------------------------- FINAL INSPECTION BY:A/ 6. ' �/ Date____.�_r -�� • ----- ------ - - % SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mant"cir California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS