12107 - Laserfiche WebLink

Home Browse Search

# FQR,OFFICE USE: . - -.- ---------------------------- -- �� t------------------------------------------------•--• APPLICATION FOR SANITATION PERMIT Permit No. ....._..•--.---........ I . (Complete in Duplicate} . `' -------- -- This Permit Expires 1 Year From Date Issued Date Issued ' Applications"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 No. 549. JOB ADDRESS AND LOCATION------------- ---- -r9- ; Q-,---- --C �tf2__C .1 __-- �' ----------------------------------------------- ....... Owner's Name --------------------------------------- Phone__,4_6�:.. Address..... -•-•---------- ••--------------------------------------------------------------------------- Contractor's Name ......15112 -----------------------------------•------------------------••----- ------ Phone................................... Installation"will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Nurrtber of living units: ___/___ Number of bedrooms _..,2__ Number of baths .. .� Lot size ----/Y_ _-X...1/ ._�_____-----_---- __ r Water Supply:-Public„rystem ❑ Community system E] Private k Depth to Water Table -- P ft. r Character of soil tova•depth 00 feet: 'Sand ❑ Gravel'o. _-Sandy Loam ❑ Clay Lam ❑ Clay ❑ Adobe M Hardpan ❑ i l Application 1atioode (!f- es,date TYPE OF INSTALLATION ------------- -----) No K New Construction: Y E]—No.n FHA/VA: Yes El No ON AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Setptiq Tank: i Distance from nearEst well__70___.._,Distance from foundation --------------- ----�_ -C�_--_-- __,.No. of compartments_-____- _�� __----------Size_________________________-__-___Liquid depth_-----------------------Caaci AGOCt Disp sa l_ield, ,( Distance from nearest well_-_4.e-r1--Distance from foundation----;fe__.f-Distance to nearest lot line... rtuber of lines_________________�____-_-__,____Length of each line---- y__..Width of trench______-. f Type of filter material______��_--Depth of filter material_____-._,(c�__-___Tota length__________ __ _ -- ------------------ 14 Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________.Distance to nearest lot line_____.---________ ❑ Number of pits_-----'__---- ------Lining material-----------------------Size: Diameter-----------------------epth----"�_- ------- I Cesspool: Distance from nearest weiL____________----Distance from foundation....----------------Lining ma'ferial_-_-_ ❑ Size: Diameter-------- ------- ."_Y`_^:,Depth. ` `--------------------------------_Liquide`Capacity----•-••--------------------gals. ` :1�w- rz Privy:, Distance from nearest well-------------------------------------'--�__. ---Distance from nearest j�uilding--}-------------_----------•------------, a ❑ w .. ._. _ Distance to nearestlot 1ine ---------------------------------------- ----------.. ` f Remodeling and/or repairing (descr•be ------ ---------------------- ------- ------- -------------------- ==- -i ---------------------------------- ---------- 7o- f- � I �� ----Z --------------------- j :_.. J -. - ------------------ : - ----- --- ----- •- ---------------------x-- ------------------------- 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 regulations of the,San Joaquin Local Health District. ►: (Signed) '-------—------ _--- y �- --,------ --------- :--:- Owner and/or Contractor) ley:.. - ------------------------------------•'------------------- '{Title] (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can tae placed on reverse side). FOR DEPARTMENT USE ONLY = APPLICATION ACCEPTED BY-__ ------ - - ---- ------- ---------------------------------------. DATE----- -�'--� ----�cZ----------- - REVIEWED BY --------F- •-------- ------ DATE--- ----------------- BUILDING PERMIT ISSUED --------------------------•------------------------------=- --------------- DATE Alterations and/or recommendations:----i-------------- -- -*-.--:-. _ ;-""F= - ---------••---=------------_-I---•---------____---- ----------•------------------ ------ -•-------- - --------- t --- '� — - -------------------------- �� ��- -------- Pf ------ - --- - ------- - ------ ----------Cad- `iz ---- --- ----- `r r --,-- . �L� r? C - r - I FINAL INSPECTION, BY:_ : - ��' �n�s�� Date------_-_--- _ --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street `- 124 Sycamore Street 205 West 91h Street stackton,'Callfornia Lodi,California Manteca,California Tracy, t 91h Stre j + E8.9 REVISED 9-59 R.P.CM]M 5.60 f