15951 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 7x-IL 3 ------- ------- APPLICATION FOR SANITATION PERMIT Permit No. ------------- 1? (Complete in Duplicate) - -------------------------- ---------------------- This Permit Expires 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 a pplication is made in cornplianiEe with County Ordinance No. 549, L�ni 44 JOB ADDRESS AND LOCATION _j -C� 4 ----------------------------------------- ------- A A-1------- ------------------- ......1-3----------------- Owner's Name---- - ------ 7 -------------- Phone.__........................... Address............. -- ----- --- - - --------------------------------------------------------------------------------------------------------*..............*---------------------------- I Contractor's Name- - Ji5--- ------------------------------------------------------------------------------------------------------ Phone................................... Installafion will serve: Residence 0"-Apartment House E] Commercial E] Trailer Court E] Motel [I Other [D Number of living units: -----L 'Number of bedrooms __-3--- Number of baths -1.... Lot size ............................... Water Supply. Public system El Community system E] Private E!rDepfh -ro Water Table 1.0 ft. Character of soil to a depth of 3 feet: Sand C] Gravel E] Sandy Loam Ej Clay Loam [3 Clay [] Adobe 2Y--Hardpan C] Previous Application Made: (If yes,date-------------- -----) No g?" New Construction: Yes gEr No El FHA/VA: Y6s E!rNo 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool p rmitted if public sewer is available within 200 feet.) A, ----------------------k------ Septic Tank: Distance from nearest well__4,!�-------Distance from foundation--------------------Material---- No. of compartments--------9�-----------size-----_1NZ4__7----:---Liquid clepth___J/------------------Capacill" .5. Disposal Field: Distance from nearest well_so........Distance from founclation-JA............Distance to nearest lot line................ Q� Number of lines_.3---------------------------Length of each line--.3e............. ------Width of trench.___- ---t.. . Type of filter materiar?OjC-,k________.__Depth of;filter material---1-k- -A------------Total length-----10��------- Seepage Pit: Distance to nearest wel[__APO_-----------Distance uprn f foun a io cl f- n...Ik-------._Distance to nearest lot line__...._.. - E!T- Number of pits.-, If 0-(--t----Size: Diameter---33- ---- --- ---Lining material--'-- -----------Depth--- ------------- i Cesspool: Distance from nearest well...--------------Distance from foundation-------------- -----Lining material-...______..______ ❑ aterial------------------Cl Size: Diameter---}--------------I-----------------------_-Depth----------------------------------------------------Liquid Capacity..------------------__---gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line----------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------- ------------------------------------ -------------------------------_.........--------------------------- ......................_f------_----------------- -----_------i------------------------------------------------------------------------------------------------------------------------------I---------------------------- ------------------------------------_------------------f.--------------------- ---------------------------------------------------- -------------------------------------------------------------------------------- ----------------------------------I-- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this plica on and tat the work will be done in accordance with San Joaquin County io r gu P, J ordinances, State laws, and rules and regulati 0 e San j aquin Local Health District. ------------------------------------------ (Signed) ------------------------------------------------------------------- ---(Owner and/or Contractor) By:------------------------------------------------------- --- --------------------------------------------------------------------(rifle)--------------------------------------------- ---------------- (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--------- ----------- /r_4 --^------------------- ---------------------- DATE---------- REVIEWED BY BUILDING PERMIT ISSUED---------------- --------I..... DATE----------------------------------------------------------- ----- ------- -----------_------ ----.. DATE-------------------- ----------------- ----- Alterations arid/or recommendations., ....... W...... ----------------------------------------------------- --------, ---7 -------- ---- ---- -- _ ----- -------I---------------- ---------- --------------------------------- I............... ...........("6-------------- ---------- ----- 4�� --------- ---- ------ -- .............................. -------------------------------- ----- -------•-----------------------------•----------------------------------------------------------------------- ............................................ ----------- ---------------------- - -- ------------------ ------------- ----------------------- ------------------------------------------------ ---------------------- FINAL INSPEC N BY:-- -------- ......... . ----------- --- ----- --- ---- Da SAN AQUIN LO AL HEALTH DISTRICT 130 South American Street 300 West Oak S?r*91 124 Sycamore Street 205 West 9th Street Stockton,California Lad[,California Manteca,California Tracy,California E§ 9 REVISED B-59 2M 5-62 ATLAS