17995 - Laserfiche WebLink

Home Browse Search

id FOR OFFICE •-- - u I APPLICATION FOR SANITATION PERMIT Permit No. .. ___� 1 S ----------------- ----------------------------- --------- il (Complete in Duplicate) --------------------------------------------------------- ll This Permit Expires 1 Year From Date Issued Date Issued'":,��g-e,.� ----------- --- -- ------ -------- -------- -------- Application is 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 L CATION H _ -- 'If ----- `_ � w F.- - _ 16 A V��--5-- - ul,llj Ax' 6iU._..lY�/�NOI� - -----.- 1� r Owner's Name --- - - - ------------•----------------------- ._______- Phone SM"K/ ,Ic Ar Iry f Address------------------------------- --- •---- --------- ------- --------- =-----------------------------------------•.•---------------•............. Contractor's NameQ15• -------1 N`� ' t Phone �D_�?_ JQ_ - Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer-Court [] Motel ❑ Other jZ 50'A'fez— P i.Number of bedrooms .------- Number of baths __,___`..Lot size __ __ _ � Number of living units: ------- - Water Supply: Public system ;Community system ❑ Private ❑ Depth to Water Table¢ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,K Clay ❑. Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) No A New Construction: Yes No ❑ FHA/VA: Yes ❑ Nox, . 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-_4116 -Distance from fpuncl jtion__,0Q---------Ma rial-___ ----- -_ _-- -- ----------- -- �7"Gt1O�Z7 No. of compartments__--TWO.-----------_Size__24_!_-X_!!?A Liquid depth---4_�-FT_:,Capacity_XW__6AL1 all Disposal Field: Distance from nearest well_tO$ .Distance from foundation-__,__-_____-Distance to nearest lot line__________ frv6?C;0 Number of lines____ StY�1'wLength of each line__. e67-11__-______.Width of french-__,3Ez11______--__-'___-_____- Type of filter material_'Z___�-�__ _ CKDepth of filter material:_�x_____ .... otal length-/��0r_ A_�-Sy10A 1� + �� Seepage Pit: Distance to nearest well-Ab!' ndation___�_5�....___.D's�ance to nearest lot line--- 61,1ht(f) Number of pits_4_FASy. fining material_ ....... _-Ce-Size: Diameter_��__-_�'-..----I)epth__Z. -- �T--------- Cesspool: Distance from I�nearest we11----------------rDistance from foundation-__.___:-_______.Lining material___-__._______._____--____'______._. Size: Diameterl-------------------------------------De th----------------------------------------------------Li uid Ca acit + P .- - q p Y----------------- -- ----gals. �. .r I] i9 C Privy:,.1 Distance from.,nearest well.--------._____________________________-___.__Distance .from,Aearest building___________,________:__ L ❑ Distance to nearest lot lire------------------------------- - --- - g p g ------------ Re o�delin and or re airs describe Qz�.--- --- --------- <tt'__-- _-•- -- -- --- - ---- -'-- -- ----•----------- �.. �-W If , --- ::: -- -------------------- -i 1 _._, i ` � � T San Joaquin Coun+yI hereby certify that I havePre aged is application and that the work will be done in accordance with ordinances, State law andr les a,nd re ul ions of the San Joaquin Local Health District. CA-A�_ � aed --- - 1� )Owner d Ctractor)(Sign -------------------- ill lBY� (Title) iu (Plot plan, showing size of lot, location of system in relation to.wells, buildings, etc., can be place on reverse side). 1. FOR DEPARTMENT USE ONLY 9 APPLICATION ACCEPTED BY------ - -------------------- DATE-------- REVIEWEDBY------------------------------- -------------:------------ ------- -------------------------------------- DATE-------- ------:---- _ BUILDINGPERMIT ISSUED----------- -- --------------------------------------------------------------- DAT ----- ------------------------ ------------------------ -- k Alterations and/or recommendations.._.__ .1 --- - ''P-��------ - - ------------- - - ad �------t - ---------------------•---- ----- -------------- ._ -----•--'------------------------------- -s^ ... rte_ .-. -c>rf4 �'` :.• s �I. FINAL INSPECTION BY:..---- . 7ZP (G - Date---- ----� _ � -------- �� SAN JOAQUIN LOCAL HEALTH DISTRICT I' 1601 E.Hazelton Ave. ll 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California h 'E5 9 REV15ED 6-59 3M 3-'63 r-R.Cq•