15976 - Laserfiche WebLink

Home Browse Search

,?OFFIrSE� _____?_ _ APPLICATION FOR SANITATION PERMIT Permit No. 74? ------------- (Complete in Duplicate) ViXIA3 This Permit Expires 1 Year From Date Issued 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 AND LOCATION Owner's Name__ - - - - 4-.- 0 G ... Z -------- Phone--- ---- Address---------=f F-�-• p - . Contractor's Name_.� 1 —__�--------------•----------------------------------------------- ----- •-- ------ Phone................................... Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._e___ Number of bedrooms _--7___ Number of baths ./____ Lot size _g_s _ _..1- _.. '-•__.___•_______________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablei _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-/-�-�.` �__) No ❑ New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well---� � _DistancePfror* foundation.__..___ No. of compartments_'__--_____- ?✓ Size__g_ _?:'�3 ._..Liquid depth _44..............Capacitye-r Disposal Field: Distance from nearest well--/`;--0'-/-Distance from foundation...... _ _..____Distance to nearest lot line................. Number of lines--------__ _. ----------Length of each line_(d.;_ 6_ t.... Width of trench Type of filter material--- of filter material-_-____ ---Total length...... Seepage Pit: Distance to nearest well_. 1_C -___Distance from foundation__//..._'__._...Dista cep o 0arest lot Rr Number of pits.____f___. .. __ Lining material.,/�C'�Z.�___Size: Diameter_ �-X�epth------ -_�__t Cesspool: Distance from nearest well____._.____.___Distance from foundation___________________Lining material------------C----,__!;;i ------------------- ❑ Size: Diameter--------------------------------------Depth----•----------------------------------------------Liquid Capacity--------------------------_gals. Privy: Distance from nearest well - ---- ----------- -- -----Distance from nearest building-.---------------------------------------- F1 ----- ------- --------.•--------- ❑ Distance to nearest lot line----- Remodeling -Remodeling and/or repairing (describe):------------------------------------------------------------------------------------___----------------------- --- -------------------------------------------------------------••---------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 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. (Signe------. I �2�._ - _�?I�!:�xux.E#..l � - -------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:................................................. ----------------------------------------------------------------------(Title)----------------- ---------- -------- (Plot 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� -�--------`) `y`-�-------------------------------------------- DATE......l � �, - REVIEWEDBY--------------------------------------------- ----------------------------------------------.._..--------- DATE BUILDING PERMIT ISSUED...................-------------------------------------•----�.--------------------------------_ DATE... -----••---- Alterations and/or--- recommendations. ate. --------------- -C-C�•-.t.Q- =,�------ �='�- -=---' - -- -:--C-•�.: f'�.- -t= --��-' --,-- ` -----�'�'- -'�-== Y"`--� == _- ------ ,�` - -� -----�=------------`-----------------� ---- r FINAL INSPECTION BY:._! ---,- --�' ---------------------- Date I-------------------------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD. '