10351 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMITPermit No. -_ �_3.5�___ A� _ (Complete in Duplicate) A /y/)( IP" Date Issued ___��'� -' -` ��C'i 6,5/- 5-37/,'sr_ Application is hereby made to the San Joaquin Local I h District for a permit to cons,ruc�"1d instII the work herein described. This application is made in compliance with County Or 4�ric 549. ►'li�x I° w� . ,F ---- --------- -- - ---------------------- JOB .=D JOB ADDRESS AND LOCATION -- ---------------�- D % S Owner's Name /Y-. Qy ------------------- ------- ------------------------------ Phone------------------------------------ Address r � ,d??�i ........ l�` - -- ------------------------------------------------------•-�--/-` ------------ Contractor's Name ' ------------------------------------------------------- PhoneA---4- !- r 47_ ` Installation will serve: Residence U?"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms 9---- Number of baths __/_ Lot size -------410� � �.�7---_________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table 4rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam[I Clay Loam ❑ Clay ❑ Adobe 2-"'Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 9?`�`No ❑ FHA/VA: Yes R�'-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if publi s er is available within 200 feet.) Septic�T k: Distance from nearest well______________ .-Distance from foundation_ Material-� __-_ U No. of compartments_-_---�--____ -___ ize_, __ s3G______Liquid depth_-._-`�-X:L-__-____Capacity____. Distance from foundation._ ____. Disposal field: Distance from nearest wellfNl_ __ - r.� _____�.___-Distance to nearest lot line_________�_ Number of lines-___________cA_______________ Length of each line---7A---_-__$Q______-Width of trench_____rr7 __-_-__.____________ J. Type of filter material_1?t__,��Depth of filter material--- ---------Total length---------1S_LO----------------- Seepage #: Distance to nearest ell'd�_ Distance fpw f%ndation-_/e_ _____.Distance to nearest lot line---- .________ Number of pits_ -----------Lining mate ria -___Size: Diameter___,3J_`r____Depth----- j__-_______ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________________________________. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity--------•----------------._gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________________-________________________- ❑ Distance to nearest lot line----------------------------------------------- --------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- --------------- ----------------------------------------------------------------------------•---------------------------------------•----------=---------- --------------------------------------------------- ----•-•----------------------------------------------------------------------------------•--------------•-----------•---•-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a laws and rul d regulations of the San Joaquin Local Health District. (Signed)-----• IN_ J--- - --- ------ ------ er and/or Contractor) gy---------------- --(Title)----- -- - ----�------------------------------------- --------------------------- - --- ------- - - - -- --- ---------------- (Plot plan, showing size of lot, location of system in relation to well , uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -- ------ DATE_=------------------ -•------------------------------- - -------------------------------------------- REVIEWEDBY--_------------------------ ------------------------------------------------------------------------------------------- DATE__V------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-----@------------ ---------------------------------- C74- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- --••-------- -' _`r ---------------- ---------- - -- - - - - - - - - - - -- ................. --- -------------- --------- �I,S' ------- 5f=---- ----- _ - --_ �"- --j--------w' -----------------------------------------------------------------------•-- FINAL INSPECTION BY:----- -a ------------------------- Date.../-gl�)) -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1-57 F.P.CO.