14322 - Laserfiche WebLink

Home Browse Search

FOR OFFC U E: ---------------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. .../...!.f.... ---------------- \A-------------------- \A-------------------- (Complete in Duplicate) Date Issued ...0 , , -, ------------------------------------------------- This Permit Expires 1 Year From Date Issued ..... 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 AN ON......................... . .............. ...-,...................................................................................................... P Owner's Name--- ........K ....... . ... .IIC....... . .................fZ� to..................................... ..... Address...................................... vona.04.. ........... ...... ..................................... Contractor's Name-------- ............ . ...................... Phone-•-----••.................. Installation will serve: Residence V Apartment House [] Commercial ❑ Trailer Court C] Motel [] Other C] Number of living units: ,/--- Number of bedrooms _-1-1 Number of baths Lot size ...........A .;r...6Z.G ................................ Water Supply: Public system M—Community system [I Private [R-0-e—pth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam [] Clay Loam 0 Clay [:] Adobe[] Hardpan 0 Previous Application Made: (if yes,date-----.--_----_-.__--) No E] New Construction: Yes [:] No [] FHA/VA: Yes [] No C3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation.......!�----Material............ 4....... No. of compartments--------:� ------------Size......R��3�T Liquid depth----------�11_1--------Ch ity...............j...... Disposal Field: Distance from nearest well_d'A__t----Distance from foundation...... Distance to nearest lot line....�t.o...... Number of lines___.-_..... ...........x --F ------------Width of trench----:___--� 14.... t. .............. ... .-Length of each line-------- --. Type of filter material....... rn Depth of filter material____/e_' '-'-_Total length-----7",r_47.... ..................... Seepage Pit: Distance to nearest well.___- Distance from foundation.....4:745F..'..Distance to nearest lot line.../..47..... &_ Number of pits........... ........_Lining material...__-,,& ---size: Diameter.AfX( ..1.'4A.7.Depth.......... ............... Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..................................... El Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well----- ........•-------------------------- -------Distance from nearest building-__....................I._..__........_.... I................... C1Distance to nearest lot line.........................................................................................................................I.,..................... Remodeling arid/or repairing (describe):_ A -----CTT_ ................................................................ ............................................................................................................. ------- -------------- .............................................................................................................................................................................................................................. 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)--------------- ........ 7 .......65� ----------- .. ---------------------------------------------------------------------------------(Owner and/or Contractor) By:----------------------- .... .. ... -- ----------------7-..7,-2...........(rifle)................................................................ - i . oc�n of�sv (Plot plan, showing sizo oc system in a ion to wells, buildings, etc., can be placed on reverse side). OR DEP ONLY F I F ........... .............. APPLICATION ACCEPTED BY---------- DATE- --------------------- REVIEWEDBY.............................. .. .......... ------------------------------------------------------------------------- DATE_------------------------7--------------------------------- BUILDINGPERMIT ISSUED.............................................................--------------------------------------- DATE......................... W�........... Alterations and/or recommenctafions:_.f.:_3/ _v------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................... .................................................................................................................................................................................. -----------I ................................................................................................................................................................... ......................................................... FINAL INSPECTION BY:. L47 Date----- ddf_-,.-- . . ......... .............................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 7 C /,1//7 4 130 South American Street 300 West Oak Street 124 Sycamore Street - oftat-west Wh?Street—" Stockton,California Lodi,California Manteca,California Tracy,California tO 9 REVISED 8-59 IM 5-61 ATLAS 6