14709 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -• r L Permit No. __-. .. :--•fi- . I@ _ -- -------- ------------------ ----- APPLICATION FOR SANITATION PERMIT ----------------- -- --------------=------------------- (Complete in Duplicate) - -Z__ _l] Date Issued ... ---_--`�- •-- - -- _----- ---------------------__.__- .__ This Permit Ex ires 1 Year From Date Issued -- - ---- - r ct for a permit to construct and instalhthe work herein described. Application is hereby made to the San Joaquin Local Health Distri This application is made in compliance with County Ordinance No. 549. l �b!� -�� I -- JOB ADDRESS AND LOCATION____ _t...:�.� --....--7••- Owner's Name-_---- .------- Phone.&I6.� 7Z . --... Addr ---•------------------••-------------••--------------•-•---------------------------------- •------------................ - ess Q - ---------- ---------------- Phone -------- Phone.-----•---------- Contractor's Name_. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 91-- Number of living units: -------- Number of bedrooms .------- Number of baths ........ Lot size __________ ____•---......_--_---__-.._-__---_---...._-__---- lic system . Community system ❑ Private Depth To Water Table .. .. f+• Water Supply: Pub y ❑ Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam r] Clay Loam lay ❑ Adobe❑ Hardpan ❑ No ®-- Previous Application Made: (If yes,date--.-- -----) No New Construction- Yes �o ❑ FHA/VA: Yes ❑ gyp, TYPE.OF INSTALLATION AND SPECIFICATIONS: �' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Ta k: Distance from nearest well_-_-----__Distance from foundation-4;2--•_------Materi`..______.__ -••- •-••• No. of compartments-------- ---------------•-Size-------� ?C Liquid depth Ca ati gi p.. P tY Disposal Field: Distance from nearest well-----------------Distance from foundation..__ Distance to nearest lot gine.___.....__.___._ ---- O M� Number of hnes___3 _ Length of each line_:-�( Width of french----��ip_.-----•-----------••-• i Type of filter mate rial_-•- kk .t'-----Depth of filter mate ;t___Total length------- -------=---------- Q � . Seepage Pit: Distance to nearest well---`sa -----Distance from foundation--_�_�__y__••_-_.Distance to nearest lot line_________________ t -•--•------ 0 Number of pits------------------ --Lining material-----------------------Size: Diameter------------------------Depth----------- --------- i it Cesspool: Distance from nearest welE_________________Distance from foundation___._____________..Lining material____._._.___________.______-._______. ' l Size: Diameter-------------------------------------Depth-------------------------------------------------.-Liquid Capacity---------- ---------gals. a Privyi Distance from nearest building : Distance from nearest well------------------------------------------- 9 •-------- ••-----_ ----------- Distance to nearest lot line---------------------------- ------- ------------ ----------•------------------- �-----"}�---� ?'��--- ''• I � �1 ` ---------------------------- Re I'odeling and/or repairing (descr' e]�A�_ �''�^-�•-------- ----------- <--------- 'rt' ---•------------ iM ----- / ' -�.. I - - I hereby certify that I have prepared this appli ton and that the work will be done in accord a with San Joaquin County ordinances, State laws, and rules and regulations o the San Joaquin Local Health District, Si 11. ed (Owner and/or Contractor] ----- --------- By:----------•-----------•------------- ----- Title --------------- --------------- ---------- --------------•--- -- -----------------•- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t: al FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED_ BY---------------- DATE REVIEWED BY---------------------------------------------- ----------- � -- DATE---------------•--•--------•--- •--------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------—--------•-----...-------------- -----• DATE------------------------------------------------------------- A?ferafions(__and r recommend"ations:------------------ ---------------------------- ----------•---------------•-------•------••------•----••------------•------------•------------- -••------ 4- ---------- --------------- I a< 1M----------- ---------- -----------------•--- -------------------- ---- •----------------------------------------- �� i' --- ------------------------------ -zj�/ ---------------------• �"" FINAL INSPECTION BY------- -----AZZ7------------------------------- SAN ---------•---- - ----- Date. - -(� 6 ----------------------- -------------- F -----•------- `Z SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteco,California Tracy,California E5'9 REVISED 8-59 2M S-62 ATLAS °K�: