18093 - Laserfiche WebLink

Home Browse Search

/FOR FFICE USE: r _d' t- -------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. 1._. a..5 •.• I (Complete in Duplicate) . a /d i --------- This Permit Expires I Year From Date Issued Date Issued __ - Application is hereby made to the Son-Joaquin Locall, ealth District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 3� 5 -`'C' ---==------------------ Owner's Name-----------a ------ `-- ------ ---------------------------------------------- ----------------'------------------... Phone__-a-E?1 _4------ �__ - '�'�+el SII Address ---- ------------------------------------------------------------------------------------------------- Contractor's Name----------PGS�---- rc..--SII---- - ---•-- ----------------- Phone--- �e -�o ----------------------------------------------- ----------- Installation will serve: Residence D� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ qI' , Number of living units: J---- Number of bedrooms ----- Number of baths --_-f.- Lot size ---7_.S____X_./- .------_--------- --------------- Water Supply: Public system 0 Community syster�� [I Private ❑ Depth to Water Table --6p ft. Character of soil to a depth of 3 feet: Sand L] Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ill Previous Application Made: (1f yes,date'�<t: )..No New Construction: Yes ❑ No FHA/VA: Yes ❑ NoX 5 TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public.sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------ Distance from foundation--------------------Material---------------------------------------------"._. ❑ M'` No. of compartments---------------------10--Size--------------------------------Liquid depth----------- ----- --------Capacity----------- `------ Disposal Field: Distance from nearest well.`.'-Distance from foundation--.�_0-_1--------Distance to nearest lot line-__-S_..____._. ;. '" Number of lines----------I------------------t---Length of each line---------aP-------------Width of french---------Awn`f_-----_----..---_ r Type of filter material---rp._,. 0 .----Depth of filter material... 8....... ..........Total len _--"-_-_---.gth --iF-9-1--_---_ .�. ,,�...,a...�.-� ----•--- Seepage, Pit j Distance to nearest weI{_- Illi--:Distance from foundation----1_Q'.._____.Distance to� nearest lot line--I_-fit__........ 4 Number of pits----------t.-._______Linings material__�--,�tU__�-Size: Diameter ____.-s c�_.'_'...i__Depth----------Z .............. P Cesspool: Distance from nearest well-------------.---Distance from foundation--------------------Lining material--"---.------------------------------ . Size: Diameter----------------- ------------- ----Depth---------------------- _----- - ------------------Li uid Capacity gals. q p Y Privy: Distance from nearest well-----._.__'I'--.----_--"____________________._._Distance from nearest building--------------_----___-_-___----..______-- ❑ Distance to nearest lot line_- -01i -------------------------------- ---------------------- #--------------------------------- ------- - 4JI t I --------------------------------------------- o Remodeling and/or repaEnng (describe}:--.-__-_ .-_ ______ _ �f _ -- --- yI ------ ------------------------------ i _ i' •----------4 ---.-� ----------------••--•--------•------------•--•------------•-------------------------- -------- ll �� _ _ I hereby certify that l have prepared this:application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and-.regulations of the San Joaquin Local Health District. (Signed)------------------ .__::-. ---------- -------------------'--------- --------------------------------- ._._.( wrier and/or Contractor) By=--------------•-•- 7-�/=------- - - : • - (Title) :� --------:- (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY s ) APPLICATION ACCEPTED BY =7 F ------------------------------------------------------- DATE------�-�, --* P �-x---------------- REVIEWEDBY---------------------I---------- - ---- #------------------ ' -------------------------- DATE------- --------•------------•--•-------------------- I� €---- - BUILDINGPERMIT ISSUED------------------ - --------------------=------------------._- ----------------------------_---_--- DATE--------- ------------=--- -------------------------- Alterations ----- ------=---- Alterations a /or re ommenda ' ns ____________ __ _ I� _ i i - ------------------- �-- -- -------- .- ' -- ----- > II C�4_- ---- - -- --- --- - ----------------------____-------_------------3..._..____.-.-_-_-."-_"---__ ------------— -..--.-..____--------.-.-_-________-_------"-.__---_.--.-_-"-"._.___________.._______.______.__._______.....__.__ ___ -_ --1- --------------------- -- FINAL—INSPECTION BY:.. - /c.� = Y Date------ �`5 ----- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT- 1601 E-Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED S-59 3M 3-'63 F',P.CU. - Lel S