21591 - Laserfiche WebLink

Home Browse Search

I ^+, FOR OFFICE USE: i �. , APPLICATION FOR SANITATION PERMIT Permit No. __... `/�• .� --. -------------= _ ____ _ �� --------- -------------- (Complete in Duplicate) Date Issued `� �� ---...� __ __ _ ----- -------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described.This application is made in compliance with County Ordinance No. 549. " -------------------------------- JOB ADDRESS AND LOCATION-" ✓ Vic'` ---------------------- --- - Phone----------------------•----•----•-- Owner s Name-----------�� _�r'-`=`:��-�-G_z--�-..--------•-- - -----•- - A�d - - r-------------------------------•--------••----------•-----------------•-----------------•--- �--- Address.---.....---��..�._......--- -�-�-------- -- -- Contractor's Name - - ------- ---------------- --------- Residence will serve: Residence [g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / ~ �� -----•---. -- Number of living units: --L.-Number of bedrooms ----/_ Number of baths _,�_ Lot size .____ ___f Water Supply: Public system ❑ 1Community system ❑ Private 0( Depth To Water Table `6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [IClay Loam C1Clay ❑ Adobe, " Hardpan ❑ Previous Application Made: (If yesdate_______________-----) No 0j New Construction: Yes No ❑ FHA/VA: Yes ❑ NoZ L TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__- ---- Distance from foundation.__ .----•--.Materia______ _ _________ ______________________ No. of compartments--------'t-------------Size__._e� - - T---Liquid depth-.._ ----- -----Capacity--- --._..__:..- . Disposal Field: Distance from nearest well-,_ _._Distance from foundation._/jo-----_..__.Distance to nearest lot line...__...... Number of lines------- ------------------ Length of each line..-----.- .. .-----Width of trench._.�_SF--��----•------•-- ( --� Total length----•-----rV......................... Type of filter material._._ ----Depth of filter material____1/1< --- Seepage Pit: Distance to nearest well___ jZ-�_ Distance fr m fo ndation..�0__-__.__.Distance to nearest lot line...r-�---- G Number of pits-_-_•.- -- __.Size: Diameter--- -- • l.__.-_- _--Lining material__-- .►- , Cesspool: Distance firomi nearest well_________________Distance from foundation-----.--------------Lining material___.____.__ - ----- ❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------------Liquid Capacity-------- -----•---- -9 ! Privy: Distance from`nearest well.__--------------------------------------------Distance from nearest building__________._------------- i i Distance to ne{arest lot line-------------------------------- # ------ Remodeling and or repairin (describe)•-- - ----- _ � •-` � > . a� �----;-- - � � ! --------------------------------- j e ...4-------------------------------------------------- ------- ------- -- --- -------------------• -------•------------------------- -------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �------------(Owner and/or Contractor) (Signed) .__�....------ ? �_------ Title ---- ----- --------------- (plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY --- DATE------- � -��J----------- ----------------- APPLICATION ACCEPTED BY-------•-- ---------------------------------------------------------- -------------- DATE---------- -------•----••----------------- --------------- REVIEWEDBY-----------------------------------------------------------•---------- •----- TE BUILDING PERMIT ISSUED---------------------------------�------------- _- --- 3---- �� Alterations and/or recommendations----------- --------------�'�----•---- � , --_. ._ ._..-_ �f C n�rr't/ .................... Date-:------- --------------•-----------------------•---- FINAL INSPECTION BY:---- `------` ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street g 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California tir ,' 'X Manteca,California Tracy,California ES 9 REVISED 'e-59.2M 5-62 ATLAS t'.