22628 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - - - APPLICATION FOR SANITATION PERMIT Permit No. ;2 ;2- -------------- ................. (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---.��i-a//O� ,7 _lY�r./,�..�o Owner's Name------- h_GiY^._ ----------- Phone-------------------------------- Address-----.--------- ------------------------------Address-----.-----•--- 40r--- ---------- Contractor's Name_ e.--17�.nrrcra.4------ �X:�-z Ql C' t/ t .l _ ----------- Phone------ ------ -------- -----•------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ /-___ Number of bedrooms _-T_- Number of baths-------- Lot size ----/ __X_��/._ '________________________ j Water Supply: Public system ❑ Community system ❑ Private E depth to Water Table-S-,41--ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ER-'H-ardpan ❑ Previous Application Made: {If yes,date-------------- j No [P] New Construction: Yes [y Flo ❑ FHA/VA: Yes ❑ No 0-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 P -- � Se tic T Distance from nearest weli�_d-_-._._.Distance from foundation__/f2._ ._._.__.Material ---- Dom _.✓.- e---------_-_ No. of compartments...__..___-_:Z-----------Size J�.-.= Liquid depth--------- 4t. ----- Capacity__f_Wz _Oy"I f .1 Disposal Field: Distance from nearest well_. ".__-_Distance from foundation___- ------.__Distance to nearest lot line___1~f_ Number of lines--------------- ...._ Length of each line �d.-1---------Width of trench--------�-� ---------------- Type of filter materiai.__/f� ----._....Depth of filter material____ .- ------ length___-__�_ye)�___________________ -Seepage Pit: Distance to nearest well......_________-------Distance from foundation---------------------Distance to nearest lot line.-_-----.______._ ❑ Number of pits--- ------------------Lining material--------------.------- Size: Diameter-----------------------Depth----------.---------------------- i Cesspool: Distance from nearest weli -------------___Distance from foundation.__ ------....... ..Lining material-------------------------------------- `I ❑ Size: Diameter- - - --- - ----- ----------------Depth----------- ---------------------- -----------------Liquid Capacity------------------- gals. Privy: Distance from nearest wel#----------------------.____._____________________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 Iw - ordinances, State , nd rules and re tions of a San Joaquin Local Health District. (Signed) --- . -- -- ........................(Owner and/or Contractor) By:------------------------------------------------ ---------------------------------------- ------------------------------- ----- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIQN ACCFPTED BY------- '- ------------------------------ -•-- DATE--------- �'� `�7 REVIEWEDBY------------------------------------------- - ------------ ------------------------------------------------------------------ DATE__..--------------- BUILDING PERMIT ISSUED---------- ---------------------------------------------------------------- -------------------- -- DATE Alterations and/or recommendations:____. -�1 X67_--.-- ----------------------------- ----------------- ---- -- �- v ------15- "� -- ------------ ----- - ---- - ----- ----- ------ FINAL INSPECTION BY:..-- .��_�4ez% r ----------------- Date......---------- -"�-- - �--- - ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press