7880 - Laserfiche WebLink

Home Browse Search

T x _..ate "e.� y AvPPLICATION FOR SANITATION PERMIT Permit�( No. ..7,_/ /` (Complete in Duplicate) �� Date Issued __.�/K/ .. . _._. Applica4-ion 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 C unty Ordinance No. 549. r _ .. JOB ADDRESS AND LOCATION---•-- --_I�.lt-._--�G._..._._._U_.______________________...................................... Owner's Name------4t`s--- -•11 ' �._L Z. - Phone......'��.O...................... i ------------------------------ --- Address.........Vo l----.............=5--- - ----- -------------- -----•-- •-•--- ---- Contractor's Name-_.__D_ , _VAr-•--••----••-•••-----•-----•-••-------•--___._..•...............•----------•-•-•-•--•--• --_. _._. Phoned.•-- �3 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: --I----- Number of bedrooms _22._._ Number o baths _.�___ Lot size _, ._�_...�_.L _______________________________ Water Supply: Public system [I Community system ❑ Private Depth to Water Table`f/�_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No V New Construction: Yes Na/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) CSeptic Tank- Distance from nearest well--------------.._Distance from foundation--------------------Material------------------------------------------------- Gl No. of compartments------ ---- ------ ---Size................................Liquid depth---._••----_- ----_----_-Capacity_----_.--------- Disposa Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line _____ Number of lines_.---------------------------------Length of each line_________________________ ___Width of trench----------------------------------- Type __-______ -___ - Type of filter material--_-- --�_.-_. .--Depth of filter material- ----- -----------Total length__............................ , 1'a - J Seepag�rPit: Distance to nearest well _.Distance from foundation �..4._____. st�nce tonearest ®/ Number of pits.-.-�-.__--.___-._.-Lining matenal_�-4��-_----._Size: Dia eter-__-_ .I?__ .......__Depth- ----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------. .---------Lining material--------------------------- El -- ---❑ Size: Diameter---------------------------_ --------Depth----•- -----•--- ----_Liquid Capacity......-.................. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El -_____ __-__._________-_. _---:_-❑ Distance to nearest lot line-------- ---------- -------- -.---- ------•---------•------------------------------------------------------- ------- ------- Remodeling nd/or repairi (describe):_... .._ G 1 LL@.(� 2�1C p�, d fl- 1 .........- .4. 14 C-M--------------------------------------------�-------------------------------------------------------------------------------------- -----••-------------•-•---------------------•---•---•-•--•-•-••••-•--------------•-•--•--------••-------•---•-------------•----•---------••-•-••-•---•-----•--------------•---•••------•----••••-•-•-...... �.. 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. L�tL (Owner and/or Contractor)(Signed) - _ Ely ---• ----------------------------------------- ----- --------------------------------------(Ttle)-••• 1l- ------- ---- ------ - ------------ (Plot plan, showing siCe of lot, location of system in relation to wells,buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_ . . __ _____t ..............__-_-______-_________-__--__-__ DATE_ ?--&Z -•__ REVIEWED BY------------- ----- -------- --- ------ "- -�"=�--------------------._ DATE_ --- ---....... -- - -•------ BUILDINGPERMIT ISSUED---•---• ------------------- ---------------------------------------- DATE............................................................. Alterations and/or`recommendations-_--------------- ------------------------ - ----•-------•---------------•---•----------•---•---•-••-•----•-- •--=•••• ---- ....•--- ............................ FINAL INSPECTION BY:------ ------• -- ^�.....z-------• Date............. _ ? ----- •-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814-North "C"Street Stockton, California Lodi, C 'fornia /{ Manteca, California Tracy, Wforois ESJ 2M 145446 ATWOOO 12-54 // �