14401 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: i APPLICATION FOR SANITATION--PERMIT Permit No. ....�.....-�... ,..- ---------- -----------------I-- --- --------------------- (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 application is made in compliance with County Ordinance N9, 549. v JOB ADDRESS AND LOCATION _ flld'al �W_Ro W. =__::.—....................................... OwnersName___X ---`---- `- E? ''`---- -----------•----•------•-•--------------------------------------------- Phone.-------------------•-•--......... Address------�� -- ... Contractor's Name.- ....I.; �- - ?�. ----- -.....-•-•--•--------------•-•------ Phone..----------...................... Installation will serve: Residence g?"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- __ . Number of bedrooms ___ Number of baths ot size ------------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ;�O 4. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®Hardpan ❑ Previous Application Made: (1f yes,date--------------------) No New Construction: Yes Delo ❑ FHA/VA: Yes M- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is within 200 feet.) r Septic Tank: Distance from nearest wel___ _ ___.Distance' frofoundation----Al2_-_-__..Hetet I__�::_ _ r .. ------- No. of compartments-----X---__-_--......Size_ j�_._._.._fk9---.---Liquid depth------ _6__....._Capacity_. . ......... Disposal Field: Distance from nearest well-- �--_--Distance from foundati n- ( ........_Distance to nearest lot line..?....:..... - Number of lines... ?------- Type __r.,____-Length of each line---� _------ Width of french-9.�./.------------------------- 99-1- y Type of filter materiai.z,4- X Depth of filter material_--�11�-------------Total length__r�_Vld._._.-_.-_----•---__--__---. r .Seepage Pit: Distance to nearest well----------------------Distance from foundation__------.--_----..-.Distance to nearest lot line-----_--__-__._.. qW� Number of pits--- _-Linin material-__•--. _--__-Size: Diameter_- _ - �1 ❑ P• -------, g ...------- d - ------------Depth--------------------------------- Cesspool: ....._....------------------••-Cesspool: Distance from,nearest well----------------_Distance from foundation.-.----`----__---..Lining material-----_------------------------------- ❑ Size: Diameter- j-;-'--=- ----------- ----------Depth-------------------------------------- ----Liquid Capacity _-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------..........-__:-------------- ❑ - - - Distance to nearest lot line_______4-------------------------------------- r Remodeling and/or repairing (describe)=----------- �� f�3�-----'� _ y'��--�_ .. ---------1-1............. .................... .. . .....................................__------- ----------I--------------------------------------------------------- ---------------------------------------------------------------------- --------------------------------------•--------••--------••--••-•---•------------------•-•- ----------------- -- --- ------------------ ----•--------------------•---------- --------------------------------------------------------------------------------------------------------------•...-----------------•---•------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul tions of;the San Joaquin Local Health District. (Signed)---------------------------------------- �!n)...`. •- -----------------By: V-----------------±---------------------10w-nre T/.or Contractor)--- --------------------------------------------------- - l ''� ` (Plot plan, showing size of lot, location of system in relat) to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY kSS---------------------------------------------------------------- DATE_--- -•-------------------- , REVIEWEDBY------------------------------------- ----1-------------------------------------------------------------------- DATE--- ----•---•---------------------------- .... BUILDINGPERMIT ISSUED-----------------------•----_-------------•- ------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------------------------------------••---............................---•---•-•-•------------_--••------------ ............... .----•----•-----------------------•------------- ........ --•-----------------------...---------------------------------------.....---------...-------•---------------------••-------------------------..---_--------------- ---------------------- ............... --_----------------------------------------------------- ---.-.----.------------•--- •_.------------..----------•-------.----•-- ----.._..-....--.--..-...-..----•--------------•---------------• FINAL INSPECTION BY:----�- Date._..., z Z 'Z---------------------------------------- , I SAN,JOAQUIN,LOCAL�HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California lodl,California Manteca,California Tracy,California ES 9 REVISED H-59 ZM 5-41 ATLAS