19910 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ----------------------------------------------- --------- 11 ------------------------------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. - ... .. .. .®_.._ --------------•-------- - (Complete in Duplicate) ------- ------- -- -- �- - Date Issued ______________________________________________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a , mit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. M JOB ADDRESS AND LOCATION• .4ol��.....•/t� o-l:`' .t�--I XPi _..•---1r---A✓----- $1--�/��. Owner's Name....................................... .............4---------- ---- Phone Address----- f55. 1./ �4QPt172 Contractor's Name p "}fi d ; ---------------- ---------• ----••--------•- ---•-•-•-•-- Phone„�a`,-- _ '? Installation will serve: Residence Apartment House ❑ Commercial b Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _!.-_-_ Number of bedrooms , .--- Number of baths _Y Lot size - MC F!iaKe------------------------------ Water Supply: Public system ❑ Community system ❑ Private LEI-"Depth to Water Table -------- 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 eNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_-_- __.Distance from foundation____!F�__,.___.Material___ j�/)1�.1 _ ....._.._._. No. of compartments--_--_-7�_1 -_Size.__-IJ-_X__/_�---_-_--Liquid depth-----�> ............Capacity__,/A-''r?.... Disposal Field: Distance from nearest well__!1_'a_____Distance from foundatiio...a.p-------Distance to nearest to� ne.. ... ®� Number of lines--_-___�__ Length of each linej�', _ f`Width of trench-_7J--/e-_-- _-._.-- �- /Lnn �� Type of filter material_,�[3+� _._ ___-Depth of filter material____,,l_�.___-___---Total length__ ___..__.____ Seepage Pit: :Distance to nearesf well---------------------- from foundation....................Distance to nearest lot line----------------- ❑ Number of pits_-._--_----_-_--____Lining material---y_ _________________Size: Diameter-_-----___-_____-.---_Depth------.---__-----_---------_--._ Cesspool: Distance from nearest well-----------------Distance from foundation._.-----------------Lining material-_--_---._-__-__---------__-__----. ❑ 61,ze: Diameter------- ----=-----Depth-----------------------------------------------------Liquid Capacity ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---.__-_---___-__-___-_--__-_-__-_------- ❑ Distance to nearest lot line-------------------- -------------------------------------------------•----------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------- -------- --.. ------------------------------------------------ ---------------------74 ------- < --- --- --------------- - ----------------------- ------ ------------------------- _--- -- -- Vic,_•----•------. 1 I hereby certify that I have prepared this application n tat the work will be done in accordance with San Joaquin County ordinances, State lay/,fflot, an Ein"relation the n Joaquin Local Health District. (Signed) ---- -------- � ----------------- ---- --------------------------------................- (Owner and/or Contractor) By�--- ----------------- ---•-•-------- ---------------------------------------------------- (Title)- -- - (Plot plan, showing ' a+ion of lation to wells, buildings, etc., can be placed on reverseside). �-- FOR DEPARTMENT USE ONLY `/ APPLICATION ACCEPTED BY---------f ►�'Q r -------------------------------------------------------- DATE------+�1-2— ` C5----------------------- REVIEWEDBY--------------------------------------------------------------------- = '--- ------j.i...•----•------_.. DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------------------..--------- ---------------....... DATE------------------------------------------------------------- Alterations and/or recommendations:----------------- -------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------•------ ---------------- --- -------------------------------- ------------------------------------------------------ ----------- -------------------------------- .................. ----- - ----------------- - -•---• ------------------------------------------- ---------------------------------------- -----------------------------•--- ---------------- -------- -------------------------- -------- - ----------------- +- ------------------------------ I----------------------------------------------------------------------------------- . c FINAL INSPECTIF Date-------------- `- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.120.