12666 - Laserfiche WebLink

Home Browse Search

_ _ 3 APPLICATION FOR SANITATION PERMIT Permit• No. .. :. -{°---- C °.. � om late in Duplicate} All, P 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 constr he work herein-described. This application is made in compliance with County Ordinance No. 549. �1 , JOB ADDRESS AND L CATION______________________ 4 � '� b 7 g! -------------. . _ - ---------- Owner's-Name..........-----ex—T s 'n ''----------- ------ ------------------------------ Phone---------•-------------------_--- ------ 1 Address _..... - ---------- ---------------------- .'Adclr ss_, Name g -----•--- �- ' -------------!^-_� '' � Phone Installation will serve: Residence Qo,Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel E] Other [I E Number of living units: __ - Number of bedrooms __-.Z-__ Number of baths __/___ Lot size _ .a-______-_-----2ti, _p-------_------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gra"vel ❑ Sandy Loam ❑ Clay LoamX Clay ❑ Adobe ❑ 'Hardpan ❑ Previous Application Made: Yes ❑ No 'K New Construction:' Yes © No ❑ FHA/VA: Yes ❑ No ❑ TYPE & INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet:}" --a. '1 Septic Tank: Distance from nearest well-----------------Distance from foundatioq_.________ ___ .Material---- ----------------------- ==-- x r] No. of compartments----------------- ---Size-----•-- ------------------Liquid de-- _ _ th------------ ;-------Ca Capacity------------- Disposal Field: Distance from nearest well.._.17r4.._.Distance from foundation_._1_0------- Distance to nearest lot line------�1.�-____ i Number of lines___._______..______..___. Length of each line-_--- _3~~_____.Width of trench--------.Z�__________________ S`o' Type of filter material---__---_�C� .__ __Depth of filter material___._ .______.Total length_-_-____._� _________________ ��___Distance .from foundafion_S_.0 _____.Distance to nearest lot Seepage Pit: Distance to nearest well_._.__.,_____._ -- --- Number of pits----------- ______Lining material--- Diameter__"___3 -----Depth___._' a.. Cesspool:. Distance from nearest well------------------ from foundation._..____:__.------ Lining material--------�'-------------- ❑ Size: Diameter--------I-------- -------------------Depth------------------------------------------- ------._Liquid Capacity-----------------------------gals. Privy: Distance from nearest wel3--------------------------------------------------Distance from nearest building-----------------------_________..______._. Distanceto nearest lot line ---------°-- --- --------------•----------------•--•---------------------------------------------------------------------- Remodeling and/or repairing,{describe}:__�r --_��T' _. ` 'c'-•--•--='---__ " ----=- ---= 'r-• + (/ �« ------- ----------------------------- . .�. ------------------------------------------- "0;- ._ .. -------------- -------------------- a -�- ---------------- ------------ - ----------�w - ----- -------------------------------=-------------------------•--------------- -- ----------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i -� A (Signed}_ ,�' ►�ri _- ---�- ----------------------- I } -------------- ;� By:--•-----•---------- J"'±^_._- ��' =s � "a -(Tic e} / - r . (Plot plan, showing size of lot, acetion h system in dlation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- DATE �ly". . REVIEWEDBY - --------------------- DATE------"------------ ----------------�--------------- ,n BUILDINGPERMIT ISSUED----------------•----------------------------------------------------------------------------------- DA --------------------------------------------- --------------- Alterationsand/or recommendations:---------:--------_-- ------------ - --------------------•---------------•------------,-----------------------------------------•----------------------------- -----------•--------------`t----------------=- ---------------------------------------------------------------------------------------------------------------------------- ------------------------------- ..---- - ------- - ---------------------------------------------------------------------------- ------------ --"----- f l -,,..f - ---------- - -------------------------- -------------------------------------------------------------------- -------- ----- - -------------- --------- ---- - -- --------------------------- w FINAL INSPECTION BY: �' �+ Date- / - ----- ------------------------------ t 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 8-'59 F.P.Cc- - -