15270 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: s+ " �-,d 2 z•Y Z-2 7 ' -----.-...__ __)iW .--�.�_ _ APPLICATION FOR SANITATION PERMIT Permit No. ..... �r- ------------------ --- --------------------------------- (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby made to the Sar► Joaquin Local Health District for a permit to construct and install the work herein described. This application ismaWopli nce with County Ordinanc No. 5 9. JOB ADDRESS AND LOCATI N__ 3.__. ••__" __.___-_ _ Owner's Namet----:;Pop ------------------------------ ------------------------------ --------------------------------------- Phone.................................. �.r32 . 7�7 s` Address........ _i .. Contractor's Name`-- --- 1 ----------•--------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of iiving units: N mbar of bedrooms Number of baths __----- Lot size _ ._q.__ Q ............................... Water Supply: Public system Community system ElPrivate ❑ Depth To Water Table. ft. Character of soil to a depth of 3 feet• Sand❑'; Gravel•❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ . J ~ Previous Application Made: (If yes,date-- -.._- ., ___fl_ No. _New Construction:'Y s ET—No ❑ FHA/VA:Yes ❑ No E�' TYPE OF INSTALLATION AND SPECIFICATIONS: may, r (No septic tank,or cesspool permitfed if public sewer is available within 200 feet.l I`r Septic Tank: Distance from nearest well_-_'`_-__-----------------Distance from foundation/tl----------------Material----- ---------------------------------------- No. of compartments_3-__-_ ---Z. ..........Size--- "; _ _ .__ --Liquid de th_____ ----------------Capacity... ` Disposal Field: Distance from neares well------------:_-D'istance.fro foundation.-_-/__a___--__:--.Distance to nearest lot line_.__(-� ... Number of lines_# ---- ---------------Length of each line____-_--0------------------Width of --.._..___ Type of filter material?_____.__Depth of filter materiel._._, ___________Total length__...._/-�__________---______________ F ,, ; �= e F SeepagPit: Distance to nearestiwell-;__________�.-------Distance m foundation---/a_./-._____ Distance to nearest lot line-_i1_.... Number of pits-_�__ I �__-_Lining material_` �ti�_-.Size: Diameter_ ?z, .�...........De th___ r t _ P ••--- Cesspool: Distance from nearest well-__-------------Distance from foundation__.__---------------Lining material _.__-_-._.-------..-.._--__-____--._ ❑ Size: Diameter =-` --------- --------Depth-------- ------------------- --------------------Liquid Capacity---------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------__.._____--_------._--.-. ❑ Distance to nearest lot rk i li`nine-----------------------------------------------------------'`- _A_�1 ------' - ---- -"----•------- ---••------••-----•---•---••-----•--------------------- Remodelin9 and/or repairing (describe .4 : ----------------------------•-•---------_--- t--•- ---'_._. ...---•--------•---- -- p --•--- --------- ------•-----------------•--•--=f---�.-._-..:-fW--••----�k------- •---•-•----------------------------`----------••-•---------------------•-----•-------------------------------------- t i H ! --•---------------------•--•--------------------•---------------------------------------=------=-------•-----•-------------------------•------------------------------•------------------------------------------- ------ I hereby certify that I have prepared this appiication and that the ork will be done in accordance with San Joaquin County j ordinances, State laws, and rules an 1 rigulations of.the San oaquin ocal Health District. + -------- --- ------ -----------------------------------------------------------(Owner and/or Contractor) (Signed)----------------•--- •------------------------- ' A - By:-------------------------------------------- - --- --- ---(rifle)--------_ --------- ----- (Plot plan, showing size of lot, location o s`yste in re ation to wells, buildings, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY I'— --- '— APPLICATION ACCEPTED BY ' DATE + --�--,S-------------- REVIEWED BY _- --------------------------------------------------------------------- DATE------ BUILDINGPERMIT ISSUED--------------------i----------------....-.-..---------------._................-"--`------. DATE--------------------------------------- ----------------- Alterations and or recom endations...... t, -- --------------p----------- j :- __--� - `�' . -------------- � � � ; FINAL INSPECTION By:------(..�. _--�------- -. -• ---- - --- -- ---------- �. Date------ -��----. (.�. -------- --- -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West.Oak Stiem 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS