15107 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- --------------------------------- ------I APPLICATION FOR SANITATION PERMIT Permit No. .. f.©., (Complete in Duplicate) �. -.------------------------------------ -------------- -. This Permit Ex fres 1 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. JOBADDRESS ANQ LOCAT ....c1JJ'- °Z-------7. -v-=------------------------------------------------------------------------------------------- Owner's Name---- --------------------------------------•--------------- --- Phone------------------------------------ Address ------ ------------------------- Contractor's Name---------- ''}•-------------------------------------------------------------------------------------- Phone--------------------•.............. Installation will serve: Residence [5" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .t----- Number of bedrooms . ___ Number of baths JAS Lot size ........_______________________ Water Supply: Public system ❑ Community system Private ❑ Depth ro Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El—FTardpan ❑ Previous Application Made:` (If yes,date--------------------) No 5R New Construction: Yes [Ey�`No ❑ FHA/VA: Yes �o ❑ TYPE OF INSTALLATION SAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well------ ------Distance from foundation_/la-------------Materia------------------------------------------------ No, of compartments----- -------------Size------ _ _lx_ "__Liquid depth__.___----------------Capacity-.Za.Ao . E Disposal field: Distance from nearest well_____—_._._._Distance from foundation__Aa_____________Distance to nearest lot line..Zr--___.-._ Number of lines.......o?..____________________Length of each line---ZXs-----______________-Width of trench.__A e.-&...-.........I..... Type ofL filter .____Depth of filter material---!g__:-_________Total length-----/s?._p......................... Seepage Pit: Distance to nearest well------T ------------Distance from foundation---AP--------._..Distance to nearest lot line--.u_ -------- Number of pits_____,`________Lining material_. 4-/C----Size: Diameter____3 - -------Depth_---- ---________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.._____-.___-__________•_------_-- Size: Diameter--------------------------------------Deth-------------------__ -Liquid Capacity_. ..gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Distance Q y ❑ e to nearest lot line----------------------------------------------- ----- --•-•--•-•----•---•------------------------------------------------------------------- 1' Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ---•------------------•------ ----------------------- ------------------•----------••----•-•-•------•--•---------------------•-------•-------------------------------------- ----------------------- ------- �i ----•---------------------------------------------------------------------------------------------------------------------•-----------------------_------- ------ A ------------------------------------------•-------------------•-----------------------------••------------------------------------...---------------------------------------------------------------------------------------- I hereby certify that I have prepared this plic ion and at the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulat s o the San aquin Local Health District. By:: `--------------------- (Owner and/or Contractor) '(Signed) Plot Ian, showing size off --c (Title) ---- s - ------------- Y ( p g lot, Iota ton of system in rely on to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-A-4/--- G`�`'- DATE.�-� '- ----1-9 1-� --------------- REVIEWEDBY-------------------- ----- - ------------------ ------------ ••--_--------- DATE.----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommend'ations:-------.-------------------------------------------------------------------- ----------------------------- ---. -- ------------•--------•--------------•---------- - Lrt-tea ------ ---::7: ------ ---------------------------------------C�------------------------------------------------I------------------------------------------- 0 FINAL INSPECTION BY- ------------------------------- Date I� SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Slrset II 300 West Oak Street 124 Sycamore Street 205 West 9th Street }� Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISER 9-59 ZM 9-62 ATLAS P