15311 - Laserfiche WebLink

Home Browse Search

i FOR OFFICE USE: -------------------- ---------- ------- ----------------- -----------------------------__..__..--_._..____.___.__. APPLICATION FOk SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Ex ires ii Year From Date Issued Date Issued ___--/.. Application is hereby made 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. Y JOB ADDRESS AND LOCATION -�2-----._��---- ----5`�R-�FT-----------------------,�1��F�.RL? i Owner's Name---------�L&F3.r=N.C� �---• F__FX - Phone........ Address----------ZU:q.---------5_------•----- Contractor's Name._.__ ,��,R; _+ ""•-- ____•_ -�. �--. --•---------- ---- -•-- - - -----•-- -..--- Phone Installation will serve: Residence Apartment blouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___r__• Number of bedrooms !___ Number of baths _1_... Lot size ..__.��_'._/2...'.-.=_..................... Water Supply: Public systemCommunity s ,stem ❑ Private [I Depth o Water Table .�--- ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam [Clay LoamClay Adobe❑ Hardpan Previous Application Made: (If yes,date....................J No I/ New E]_ Construction: Yes � [:1ElNo FHA/VA: Yes El No PE []� TYOF INSTALLATION AND SPECIFICATIONS: M (No septic tank or cesspool permitted if public sewer is available within 200 feet.l Septic Tank: Distance from nearest well.-AICAVEDistance from foundation----IV---------Material.._REDW0Oj� --.---- No. of compartments,_.____,�-----------Size.3_ _�__X_,7 ---Liquid depth-------�------------Capacity._-_ 0- -- Dispo I Field: Distance from nearest well_111Q1Vf, Distance from foundation___ _ s --------.Distance to nearest lot lir,,-. -----_- Number of lines_______ _______________________Length of each line______40---.-------------Width of trench------- - -- --} ."�-- Type of filter materiai.R -_-Depth of filter material.,JCZ :".Total length...------- "__ ---01 r Seepage Pit: Distance to nearest well______________________Distance from foundation___-___.-_-_._._-__.Distance to nearest lot line--- ❑ Number of pits----------------------Lining material-------_------------.Size: Diameter-----------------------Depth---------------- ---------------- - I i' Cesspool: Distance from nearest well-_____--__-_.._Distance from foundation-__________.-------Lining material____________________________________ ❑ Size: Diameter------------- -----------------------Depth-----------•- --------------------------------------Li Liquid Ca aci i ; q P tY----••-•--------------------9als. Privy: Distance from nearest-well----------------------------7!!7T --Distance from nearest building 1�" i ❑ Distance to nearest lot line. ---------------••-----------•---•---•--•----------•---------...------ 4 . 1"' : I Remodeling and/or repairing (describel: --- I y ' __-__.__„.._. ___________________________________ ! 9 ________-. w # _--_________••______________________________________________________________________..__________________--__--_ _______________________________________________________________________________________________________________________ - ' _L - p ________ _ _________________________________ __________________________._-__._._ I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed -----------------------=.-_(Owner-and/or Contractorl By:----------••--------------=-----------------------------------------------------------------------------•-----------------------__(Title)---------------------------------- ----..-------- -------- (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 / DATE--.-- 'S REVIEWED BY ---- -------------------------------------------------------------------------------------------- DATE-------•---•- -- BUILDING PERMIT ISSUED---------------------------------------------------•--.....•------ ----- . DATE........ Alterations and/or re ommen ations-------------a--- - ---------------------__ ------•---------- - -- �.�4s 1 - -Qsl_-_i----`---x-43•--a- ----------- . ------------------------------------------------------------------ -•-- -------------------------- ---- FINAL INSPECTIO Date--------- -=--- - ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California _ Manteca,California Tracy,California SES 9 REVISED a-59 ZM 5-52 ATLAS