12088 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No/ ,Z�91;11' ................... (Complete in Duplicate) k ThisPermit Expir6s I 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 madein compliance with County Ordi o- 549. JOB ADDRESS AND. ATION 4 -- ----------------------------I----------N---------------------------------------------- 1,0C- ------- - Owner's Name------- 'Phone------- --------- - - - --- ----------------- - ----- --------------- ---------------------- .................. Address--------------------=-- - - ------ - - ----- - ----- -------------------- -------------------------------------------------------I------------------------........ Contractor's Name-------T ------=---------------------------------- Phone----------------------- ------- Installation will serve: Residence Apartment House 0 CoTmercial L] Trailer Court E] Motel [I Other E] Number of living units: I--- Number of bedrooms c;.L Number of baths 9 Lot size --- -t� Water Supply: Public system X Community system El Private E] Depth to Wafer Table—,-37).- ft: Character of soil to a depth of 3 feet: Sand C] Gray.el_E] Sandy Loam 0 Clay Loam 0 Clay E] Adobe2 Hardpan E] Previous Application Made: Yes E] Nyr& New Co'ns'fruc+ion: Yes M No El FHA/VA.. Yes El' •No TYPE OF INSTALLATION"AND-SPECIFICATIONS:—— -2` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank, Distance from nearest weli----bWMk,.Disfanc6.jrom founclaf ion-----I-0---------Material-__4SW*WA ,P� GWAA�, 91 No. of compartments______2—-----------Size--,:-� --------Liquid depth----4----------------Capacity. D I Field: Distance from nearest, eli.U. UA'Dist�nce from foundgfi�n.j- -----------Distance to nearest lot line____ 44S 4Im f6 0 Number of lines---------;4 Length of each linei�-, 55"--Width of trench--- --------- Type of filter material______,-._ Depth;of filter material-----I- ---------------To�al length---i-I&A- --------------------------- (A Seepage Pit: Distance to nearest well-.--__------------ bisfanuefrom foundation_____ _______---___.Distance to nearest lot line___________.__"._❑ of pits---{ ------------�'Lining-material----7-- Diameter-----------------------Depth--------------------------- Cesspool- Distance from nearest well-----------------Distance from foun"daf;on--------------------Lining material___________________________________- ❑ aterial------------------------------------- F1 Size: Diameter-----.!----------• I----------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------+------Distance from nearest building------- ----------------------- -----. ❑ Distance uilcling----- - ----------------------- ----- Distanceto nearest lot line-..-------------------------------------------------------------------- --------------------------------------------------------- ------------- Remodeling and/or repairing (describe):--------------------------------- ---------------------------------------- ------------------------------------------------- ----------------------------------------------------f 0 ----------------------------------------- -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- --------------------------------------- ----------------------------1-11-------------- -----------I-------------------------------------- ------------------------- -------------------------------------------------------------------------------------------------------------A-------------------------------------------------------------------------I---------- I hereby certify that I have prepared this'applicati'o'n-and that +he work will be done in accordance with San Joaquin County ordinances, State laws and rules and regulations of the San Joaquin Local Health District. (Signed)-- - ----- - -------------------------------------------------I ------(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 REVIEWED BY-------------------------------- ------------------------------ DATE APPLICATION ACCEPTED BY------. -4v- ----------- ------ ------- --------- - -------- ------------------ -BUILDING PERMIT ISSUED------------------------------- ------------------------------------------------- --------------- DATE----------------------------------------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------- ------------------------------------- -------- A ---------- ---------- 4-------- --------------------------------------------------------------------------- -----------, ------------------------------------------------------- --------- ......... -PV E-7 R ----------- 14. --------------------- I-Av Nk5 +--��,Fl At A- -----P/-77c-H--------- �7 ......... FINAL INSPECTIO Y:-- Dafe-------/=1.... SAN JOAQUIN LOCXL'H'EALTH DISTRICT 130 South American Street 300 Wosf Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4r ES-9-2M Revised 6-'59 F.P.Co.