11583 - Laserfiche WebLink

Home Browse Search

V/ ✓ / 1 �a APPLICATION FOR SANITATION PERMIT Permit No. ...�1�......3... (Complete in Duplicate) 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-------1-1 .... --------------------------------------- -- Owner's Name--------- ��e;IZ- "1?_-------------------------------------------------------------------- Phone*--.�` � / Address----------------------------------------------------------0 _,La---------------------------------------------------------------------------------------------_------------ / Contractor's Name--- --_ '�0L ? �t 92 Contractor's Installation will serve: Residence 0 Apartment House ❑ Commercial Ito Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..____ Number of bedrooms -.,3-. Number of baths I.._ Lot size -___________________ Water Supply:I : Publicsystem 01Community system F] Private F] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 16, Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Distance from nearest well_�g� __Distance from foundation_--_Z,�_�------- ............_ No. of compartments-----f------------------Size_S'T rr ---4Z_ ---Liquid depth ig'r------------Capacity...... ----•-- al-AAi4�� sposal Meld: Distance from nearest well..........:......Distance from foundation--------------------Distance to nearest lot line................. Number of lines___________________________________Length of each line___-_-_____-__--_____.__-__...Width of trench------------- ______._-_____-___ T' Type of filter material-------------------------Depth of filter material-----------------------Total length----------------.:________=--------------- /� Seepage Pit: Distance to nearest well__/ —_.:Distance from foundationsg:;E�. ._...Distance to nearest lot line....... ...... Number of pits----/---------------Lining material___1 - __-..Size: Diameter____.3_.3__'*-------Depth__.-__�--47............... Cesspool: Distance from nearest well-----------------Distance from ounclation--------------------Lining material__-_------_.___-_-_.__--.._-.---_-_-_. ❑ Size: Diameter------ -•-----------------------------Depth-----------•------------ ------Liquid Capacity---------_---------_.....gals. Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building--_----___-_.__----_-_---_--_.----__-_---. ❑ Distance to nearest lot line.---------------------------------------------------------------------- -------------------------•------------------------------------------- Remodeling and/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, State ala jwss,, and rules and regulations of the SSaann Joaquin Local Health District. (Signed)-- --`A nd - �ACj J�e {.Q.fl_ _ EJ_`.V( Q------------------------------------- Contractor) BY:------------------------------------------------------------------ (Title)---------------------------------------- ----- -- ---- --------- (Plot plan, showing size of lot, location of system in relaf to wells, buil ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_---------- ----------------- --_____ �... �------------ -------------------------------------- DATE---------------. . fes.-.______-._____-__--__--.-_. - REVIEWED BY---------------------------------------- --------------------------------------------------- DATE-------)------------------------------------------------- ----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations----------- -------------------------------------------------------=-------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- ------------------------------------------------------------------------------------------ --------------•----------------------------------------------------------------------- ----------------------------------------------- --- --- ------ ----- ---------------- ----------------------------------------------------------------------------------------------- FINAL INSPECTI Date_____1—.9176.0 - . . . . --- -- -- 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 VV ES-9-2M Revised 8-'59 F.P.Co.