10065 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT !Permit No. __ .v _ _ (Complete in Duplicate) ......... A lication is hereby mad : Date Issued __� z-��s pp Y e to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made inl�compfiance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__j2_?/_ E ---- -------� , Owner's Nam I -- - ---- - -------- Address - I ;>------ �� - 7--------------- -- Phone. t :..� -- W--- ne -----------------------------------------------Contractor's Name_- 9Installation will serve: Residence ------------_-.------------ ❑ Apartment House " +E ii ❑ Commercial [] Trailer Court Motel Number of:livingunits: -_--__-- Number of bedrooms -------- ❑. Other UK Number of baths -----___ Lo+ size __ 41;_ - 'S_ `a`�i�1) -1 Water Supply: Public SYS tel�rn iCommunit system �O -or ---------`------------ x 1I• Y Y ❑ Private ❑ Depth to Water Table _-.----- ft. II Character of soil to a depth�1.of 3 feet: Sand Previous Appiica+ion Made: Yes ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ h Adobe„ Hardpan ❑ ❑ No X__ Construction: Yes�o ❑ FHA/VA; Yes E No,� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or c esspool permitted if publics s wer is availp �i in 20G* ��f ,` Septi Tank: Distance from nearest well' ""'Dista fror f ndation- _ '� No, of com artments-_-- - p�� G► Materia!_-_--1 acs- ' rquid depth--------- _ �' U Disposal Field: Distancefrom neae weld•-_ - __ Distance to Capacity !3-___ --'.Distance from foundation---� 4 Number of lines-- nearest lot ane--- _, -- -- Length of each line_- --- -___ f Type of filter material- _ �, -----Width of trench- l� I. --_-_-Depth of filter material---_ _ __ --------- � Seepage Pit: Distance;to nearest well_-- Distance from found --Total length�, W ation--------------------Distance to nearest lot fine-_---_..---_----- ❑ Number of pits----------------------Lining material-------------- -Size: Diameter Depth- Cesspool: Distance j�from nearest well----- C Distance from foundation-- _--_-__--__--Lining material__________________ G { ❑ kSize: Diameter---------------------- i Depth Liquid Capaci+Y Privy: Distance from nearest well-------------- -------------------gals, ' ......... --Distance from nearest buildin II ❑ Distance to nea-est lot'line____A_____ g ------ --------------- l ------------------ - --- emo tiling and/or re pairing�l(describe)-------------------------------------------------------------------------------------------- ---------------------- 91 II-----------------------------------------'--.----------------------------------------------`--------------•--_--- _---_"------------------------------------------------- -------------- '' ------ --__---------------------------- ----_.-•--•-----------------------------------•-•-----_-------- I hereby certify that I have prepared this application-- - -- - T-----------------------------•-------•--------------------------------------•-------- e work ordinances, State a6, and rules d res ions of the"San Joaquin Lcal HealltheDistricfn accordance wiith San Joaquin County (Signed)------ -- I I h - ---- --- --------------------------------------- ---------------- By: – I ---•--------- --- - " Title ----------------- (Owner and/or Contract d o ( P --------------------------------------- (Title) 1� o+ an, showing size of lot, location of s system in relation to wells, buildings, a+c., can be laced an reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED Byb _ REVIEWED BY ` 1� f BATE- BUILDING PERMIT IS'SUED--_--_��------------- -- ------- DATE---- ,- 1--+ - ------------ - Alterations and/or recommends`+ions:--.-_------ DATE--------------------- --• - i ---------------- i ---------•--------------------------------- --- -------•------------- ------------------ - -- ----- ------------------- --------------------------------- ---------------------------------------------------- - ---------------------------------------------- ---------------------------------------------------- -------------------------------------------------*-------------- -------------I----------------------------------------11 1 ---------------------------------------------- - ---- 1�------------------- ------------------------------ ---------------------------------- ------------------------- ---------------------------------------------------------------- --------------------------- -------------- --------- --------------- - -------------------------------------------- - ------------------------------ FINAL INSPECTION BY:. t -------------•---- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S}reat I 300 Wes} Oak Street Stockton, California 132 Sycamore Scree} L 814 North "C S}ree+odi, California Manteca, California Tracy, California �5---9-2M , Revised 1-57 F.P.C6.