12825 - Laserfiche WebLink

Home Browse Search

JC, -- ^PPLICATION FOR SANITATION PC,tMIT 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 permit to construct and install the work herein described. This application is made in compliance with County O inance No. 549. JOB ADDRESS AND LOCATION--- Owner's Name-- ---------------------------------------------------------- Phone a � Address ------- - ---- -- - -- --------- Contractor's Name_ y.--Pr-- - ---- ------------- --- --------------------------------------------------------------•--------------- Phone__MQ�_-f* 577416. Installation will serve: Residence ❑ Apart ent H se ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other CA MPP) Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ______________________________ _________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ 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: Yes ❑ 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 Tank: Distance from nearest well_LQ_y-_Distance from foundation_-A-0-A_-_.MateriaLl� C 2 i_t-knur�st�3trr, No. of compartments_-.____- _ Size_ 11 - ----- _Capacity__ ,, Disposal Field: Distance from nearest well-_t;Z _Distance from foundation_..kj__':#-____.Distance to nearest lot line_________________ PdGmber of lines_.______-----------------------Length f ach line-__-_QC3_!__----____...Width of trench-_--_Lr-`__--_-.--_._-_-_-_-- e of filter )in ri I O_[;. ____Det .� � t ri 1 Total length i p 9 Seeparle�ilfl tti, • Distan6_+Cl rearest-well=______�_-.--_-_-__Distance from foun a i __.................Distance to nearest lot line__-___--_-_-____ �.. r�> ❑ �f. material-----------------------Size:, iameter-----------------------Depth--------------------------------- Cesspool: -_.--_ -_ ------- ------ vr� Cesspool: rDtn�re from nearest well_ ______--._.Distance from foundatio -------------------Lining material-------------------------------------- ---------- ____ _________________ ___________ ❑ ' [3iameter -�--•-----------Depth------------- =: iq�rid-6�pacitY =gals. � T l � p, Privy: Dis ante from nearest well _ __ _.___+�.,�.,,., sf3(Ce Arom nearest building.________.___.___________-____-.--_--. ❑ Disstan�e to neatest lot line ------------------- ------------------------------------ ------------------- -------------------------•-------------------- Remodelin and/or ? air,n sc'r' 9 d/ �P . ---------------- ,--fl 9 --------------------------------- --------------------------------------------- ---------------------------------------+ks' t t � *#I*- -------------------- ---------------------------------------- -------------------------------------------------------------- - --- ------------------------------- .• - hereby certify that I have p/epared this application and that the workiwill bed e'inrdanc� with San Joaquin County brei ante$,-�SEtaf�iawso anOules'and regulati s of the San Joaquin Local ealth District. i (Signed)4 i� D -------------------------------------------------------------- (Owner and/or Contractor) i- 4' -�^ -------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- x= - ------------------------------------------------ DATE--------;Z--- REVIEWEDBY -------------- --------------------------------------------------------------------- ------ DATE---------------- --------------- BUILDING PERMIT ISSUED_____ _______________________ , -- DATE__-_----_-__-______ --------------------- ` yAlterations and/or recommendations:------- !`----t-, I ------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------ ----------------------- ----------------------------------------------------------------- ------------------------------------------------------------- ------------------------ ------------------------------------------------------------------- ----------------------------------------------------------------------------------------.-_----------------------------------------------------------- - FINAL INSPECTION BY:-.---J_,------- - ----- 1 ----- ------ Date--------------------------------¢'--- - --(S.J---�---------- 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 E5-9-2M Revised 8-'59 F.P.Co.