10696 - Laserfiche WebLink

Home Browse Search

r APPLICATION FOR SANITATION PERMIT Permit No. (Com let p e 1n Duplicate) ,.� Date Issued '� -_;)7 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 LOCATION.-_-__ _ /I-_-_--_U ------------------ Owner's Name. ----- -- l --------•----------------------- - ------ Pkone-------------------------------- Address - --------------------------------- &I ^' -- -------------------------------- --------------------------------------- ------------------------------------•--------- Contractor's Name �? , - ---------------------------------- - --------------------------------- Phone Installation will serve: Residence 5]fApartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f--___ Number of bedrooms _ Number of bathsI_-_ Lot size _----. ----------------------------------- Water Supply: Public system [DI-_Communify system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Cla Sandy Y Loam❑ ❑ y ❑ Adobe[9'Hardpan ❑ Previous Application Made: Yes ❑ No [0-""New Construction: Yes ❑ No © FHA/VA: Yes ❑. No ®-1 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---------------------- - � S;..11 1 ; No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- ----------- Field: Distance from nearest well.--___---__-----Distance from foundation-----------------_.Distance to nearest lot line-_---__--------_- is "(-1 Number of lines-----------------------------------Length of each line------------------------------Width of trench __ --- ------------ --------- - - Type of filter material--- __ _ ----- _-_____ ---- -Depth of frlfier material----------------------rota! length--------------------------------------_--- Seepage Pit: Distance to nearest well!'! ------Distance frog found ation_ /_k►_�____-_-_.Distance to nearest lot line_-- Number of pits_--._j---___----____Lining material__.k:i ------ Size: Diamete r-- %'`' a --Depth------IN_ ----------- esspool: Distance fs-om nearest well-----------------Distance from foundation-------.------------Lining material____._ _-_ El Size: Diameter---------------- ---- -- ------------Depth----------------------------------------------------Liquid Capacity------------------------------------ g ------ els. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building Distance to nearest lot line___________________________________ Remodeling and/or repairing (describe):_____-j._i: a _: • ' -- - .'lT.. a n --- ----- 1^ ------- -•----------- ---- -- -----�!L----� -----= � -------------- --- S- -----d.a_YZ& r___f�kr-- -- - 4�= ---------•-----------------------•-------------- --------------------------------------------------------------------------------------------------------------- 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-re ulaft ns of the San Joaquin Local Health District. (Signed).------------ l-;__--�--_----------------�--- ---------------------- --------------------------- -------------------------(Owner and/or Contracfor) f By:----------------------------- ---------••----------• (Tile _____ -------------------- ---------- - ------------------------------------------- --------------- - ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _ _1 � --. a /, ----------------------------------------------- REVIEWED ----------- --- DATE------'- BY ----- --------------------------------------------- ----------------------------------------------------------- DATE------- - -------- -- �- -------•-- UILDING PERMIT ISSUED-------------------------------------------------------------- Alterations and/or recommendations:-------- - DATE ----------------------------------------- ------------ ------------------ NTp-----DF-?' ).--- 7-7-----------. -M.c-K�---�.� _t':_�A.�1= '!+-7d. - -----------he�"H.... *S`-� ------------------------------------------------------ FINAL INSPECTION BY:_, _ 7 Date.--------3--`_1-7-7 - ------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 Soufh American S+reef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manfeca, California Tracy, California E5-9-2M . Revised 1-57 F.RCO.