11907 - Laserfiche WebLink

Home Browse Search

Permit No. ---f�.�A 7--•- APPLIC�. ATION- FOR SANITATION PERMIT I [Complete in Duplicate) pate Issued ---_Yj_1?1&L1. This Permit Ex ire; I Year From Date Issued 1}h Dist 'ct for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health This application is made in compliance with County Ordi c 549. ` ` --•---------------•----- JOB ADDRESS AND CAT ON 2 -� Owner's Name ----- Address_. h one _ .� Ph --- - - Contractor's Name------------------------------------ Motel ❑ Other ❑ Installation will serve: Residence ��APartment House ❑ Commercial ❑ Trailer Court ❑ /gip- k Number of living units: _ -- Number of bedrooms . --_ Number of baths __ -- Lot size __ _ _ Private ❑ Depth to Water Table - {}. Water Supply: Public system �omSa nity system ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Character of soil to .a depth of 3 feet; Sand ❑ Gravel ❑ Sandy Loam ❑ Y HA/VA: Yes ❑ No ❑ Application Made Yes ❑ . No ❑ New Construction: Yes ❑ No .Previous App• . f TYPE OF INSTALLATION•AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Distance from nearest well____-�--------Distance from foundati�quid depth--Material-.--:- _-Capacify_.___-------•---------- ti' / No. of compartments___ - --.--- 1Ze-- , Distance to nearest lot ine_________________ _.Distance from foundation___ ---------- --------------- Disposal F Id: Distance from neares�t•�well Length of each line____--; �- Width of trench___- -- t Number of lines_______�.J �• of filter material___-- -- - _ Total length---�c�-----=------------�•�---- Type of filter matenal__S! - -Depth gist nce to nearest lot line____ undation-_��-�-- pistan - De tk---- S-------------- Seepage Pit: Distance to nearest ell_ Linin materia ____ ---.-Size: Diameter--; - ---- p L� Number of pits----- ---------- g Cesspool: Distance from nearest well-----------------DDiist Ince from foundation'.------------------ ---- --__ __Liquid Capacity_ ___---------------------gals. ❑ Size: Diameter------------ --- Distance from nearest we1!-------------------------------------------------Distance from nearest building_____-_.---------------------------------- Privy: ------------- ------ ------ --- Privy: --- - ----------------------------- ❑ Distance to nearest lot ine--_________________________ ---------I--------- -----------------------------------------------------------------------•-- ---Remodeling and/or repairing (describe]------------------------- - __-.________________ ---------------------------------- ---------------- -------------•-------- _ of that I have prepared this application and that the work will be done in accordance with San Joaquin County I here Y R ordinanc s, ate ws, and rules and regulations of the San Joaquin Local Health District. ----------------- - --- -------------------- - --- --- caner an r Contract ani/or - --------------- - S� ned ------ -- -- ;^- 9 ------- I.g } -- - - - - ---- (Title)------ ------------------- --- ----- -- - BY:-------------------------•--•----------- - b mgs, etc., can be placed on reverse side). 4 (Plot plan, showing size of lot, location of system in relation to wells, 4 FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY_ ,_--- - --�/�' y -- --------------- DATE_ 77/1-57-- -------------------------- ------------------------------- APPLICATION ------------ ----------------------------------- ---- ----- DATE------------------------------------------------------------ --- ----------------- REVIEWED BY--------------------------------------------- ------------ ------------------- ---------- - DA BUILDINGPERMIT ISSUED------------------------------------------------------ --------------------- - -- - - --- -------------------------•-------...----------------•------------- Alterations and/or recommendations------------------ ----------- --- - -� . -- ----------- - ---------------------------------------------------- ----------------------- -------------------------------------------6------- ---------------------------- Date-------y--�-� ---- - �--- ----- ------- ---- FINAL INSPECTION BY:_e--.C-,- 71 " - Z-l-- ----- .------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, Galifornia ES-9-2M Revised 8-'59 F-P,Co. _