9671 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �y (Complete in Duplicate) t Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr;bed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_-____--- ---------------- C-1 d I� _o- -� E r Owner's Name----------FJ__;t .�1-�_ , y ------ -- - PhoneI'_{lc ----`t 7_y`.�- r Address- �2 C�/Y7 - --------------------------------------------------- }� ----------------------------------------------- Contractor's Name------ Z1 -� / L� -- r y V. � - --- ----- -- - --� - �-t`---•- --------------------------- Phone?/L_..-�_s{,'�� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __t___ umber of bedrooms ..r y- Number of bathsL f -- ot size ---�..G--- ----�--�--�'�- -------- Water Supply: Public system y Community system ❑ Private ❑ Depth to Water Table 0)_,6Pft. Character of soil to a depth of 3 fest: Sand'El Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ElAdobe. Hardpan ❑ Previous Application Made: Yes El No [3 New Construction: Yes F1 No ElFHA/VA: Yes ❑ No 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--Mt N-gE_Distance from foundation_ ' j '�_ -. Material " No. of com artmenis- ----� �"`--- p Size. - '� Capacity Liquid depth..,. " . _ --- Disposal F efd: Distance from nearest well.(I*GKkI- - -Di�anc�fr"omrfoundation._/_0./-___--Distance to nearest lot lige-----�...------ i Number of lines..__.-�____ Length of each line.._ s %_ ___----. Width of trench.... `` Type of filler material. 1c,/ -Depth of filter, material__ ._ p`` ----------- Sy- ,��]._- -_-----Total len th-__.° / Seepage it: Distance to nearest well-aL1t 41P-_----_Distance rom foundation__(. ` UK .._.__._-..Distance to nearest lot line_-..._�____r Number of pits.....I---------------Lining material-- �c—c. �.----.Size: Diameter- r.' _- •• Depth_. _ _-- Cesspool: Distance from nearest well---------- -----Distance from foundation- _____--_-__--____,Lining material._...-_____-____-.--_ .- ❑ Size: Diameter. ----------- ------ -- - - - Depth--- - ---- -------- ------ Liquid Capacity--------------------------- gals. . Privy: Distance from nearest yell----- ---------_____-__ ---..Distance from nearest buildin ❑ Distance to nearest lot line------------ g------------------------------------------ -------- ----------------- --------------- -- ---------- ---•---------•--------------------------------------- Remodeling and/or repairing (describe):-------------------- ------- ----------------- -- ------------ ------------------------------- ( V - ------------------------------------------------------------------------------- -----------------------------certify that I have prepared this---------------------------------------- ----------- - - - ----------------------- ------------ --------- ------------------------------------------------------------ s a application and that the work will be done in accordance with San Joaquin County I hereby certi ordinances, State laws and rules and re ulations of the San Joaquin Local Health District. DAA' & NIGHgf ' (Signed) EPTIG TA[�IIC-.S.ER. 1. __. i 2505 E Miner Ave., - Stockton 5�Cali#. -- -- --------------------------------- Contractor) SLC Contract f °r) r HO - -----------(Title-------------- Plot plan, showing size a y ( p g �o , oc n o system in relatigrt o wells, buildings, tc., can be placed on reverse side). FOR D ARTMENT USE ONLY APPLICATION ACCEPTED BY--- -----------------_ . DATE------ REVIEWED ---- � DATEBULDNG PERMIT ISSUED--------.-- _- ------- ------------- ------------- DATE..---- Alterations and/or recommendations: -1 -------------------------------------------------- I --- ------- ---- --- ------------- -- -- --------- -------------------------- -- ------------ - -------•---------- --- -------------------------- -- -- - -- -- •--------------- - --- -------- -------- - ----- -------- ........................................................-._..._-.--...__..--..--..----.------------.----- .__-..................."r r _.._-_ 1. ----._--_ FINAL INSPECTION BY:.. Date- 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.