15600 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USI:: --------------------------=------------------------------ _ -------------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit:No. ... ....:1 ..�J ---------------- --------------------------------------- (Complete in Duplicate) f ,�, Date Issued ------•--------------------------- - -. ---------.--- --- This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w41 'b�rk herein described.This application is made in compliance with County Ordinance No. 549. .r 1s EiI JOB ADDRESS AND LOCATION_ ______------__________ ." Owner's Name------- -------•-------•--------------------------------------------------------------------- Phone]----------------------- -Z . . .. ._. �..... .___ /.._ ........--------------- Address ...... ------------------------ � • ........... Contractor's Name--- f ....... Phone. . ...--•••-�ee ... ..... i ' i Installation will serve: Residence IE Apartment House E] Commercial [—] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .!-.--4 Number of bedrooms _.._. Number of baths I.... Lot size _. ti-----•-- ------------------------------- Water Supply: Public system ❑ Community system ❑ Private IV Depth To Water Table . .. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No C� New Construction: Yes No ❑ FHA A- Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k Distance from nearest well_ 4�-------Distance from foundation---/?�-------.Material_-1��L------------------------ F I E No. of compartments----Z-------------------Sixe.��.`_`.�____ -_ F-�._--Liquid depth------3.9-�'-----------Capacity./� �-t-______-- IIII . Disposal Field: s ance from nearest well.7P----.._._Distance from foundation---/2-----------Distance to near5st lot line._r�---_•_-- ,� Number of lines___�------------------------ Length of each line__J_ -----------------Width of trench llAt� _G--.--_--------_------ T e of filter materia !'_'._...•_Total len th.__� ----------------------------- I[ __-_-._ yp ___._�,r�___Depth of filter material___f� g _ ____________________ Seepage Pit: Distance to nearest well_____----------------Distance from foundation....................Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material-----------------------Size: Diameter--------------.........Depthff--------------------.------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth---------------------------------; ---------------Liquid Capacity -----------------------....g i Privy: Distance from nearest well--------------------------------------------------Distance from nearest building..---_I. ._______.___________.._____._. r ❑ Distance to nearest lot line--------------------------------------------------------------------- ------------ ---------------------•11=--------- •---------------- Remodeling and/or repairing {describe)-------------- ... Q._. e'1,t --- 2 �°i*�_---------------.------------------------•---•--- II, ----------------------•----....---••-------•--------------•---•------------------------------------------------------------------------------------------------•-------•- •----•-------------------- ......... ' ---------------•---------•----------- --------------------------- I hereby certify that I Have prepared this application and that the work will be done in accordance with an Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed�Y5- - �. ------------------------------------------{Owner and/or Contractorl I -*-li� ------------- I_. - -- ------------ -- (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 BY-- -------- ------------------------------------------------------------- DATE-- ----------------- REVIEWEDBY-------------------------------------------- ------------------------------------------------- --------------------------•--- DATE--------------------------M--- ------------------------------ - - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.----.--------------- -- 1M-------------------------------- Alterations and/or recommendations--------------- --------------------------------------------------------•--••-------•-------....-----•-•----...------.....--1f--------------------------------- .......................---------------•--•----------------------------------------------------------------------- I' --------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------{l'----------------------------••--- ------------------------------------- ---------------------------------• - -- ------------------------------- •-------•--------------------•----- -•------------••------------------------------------------------------ FINAL INSPECTION BY:. ---- Date--------------------------------_----------------------------------------------- SAN - -. _SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wrist Oak Stmt 124 Sycamore Street 205 Wort 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS I t !II i