11708 - Laserfiche WebLink

Home Browse Search

CA APPLICATION ..FOR SANITATION PERMIT Permit No. ..i.t. �?. r.._.-. y�. .. _ �. p r,a�c, � 6omplete m Duplica+e] Date Issued --- -�-- " This Permit ---- Expires 1 Year from Date Issued J 4(Zz�-lam _ ... +� r �._. ApplicationVlhlby ade to the San Joaquin Local Health District for a permit to construct and install the work herein desc ibed. This applic tion is rl+ad in com lien with County Ordinan 549. , *- 1�55 O 1 ------------- - - - - JOB AD LO ATI ------- --.��, -----------1�=--- '� - ---- - -- .- F one-------------------- '�. {r _-z -------- Owner s Name-::---- " - ------ - •------- - ----- -------- 1 4 V ----- Address__..--------� ` = - lr R ,. I e . . -- a.- Contractor's Name--------- --- ---��--I--- _ •.. Installation will serve: Residence 2�L Apartment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other ❑ ► 0--A--` rr��_-- Number of bedrooms -I... Number of baths _ r Lot size _________ _ __ _ ==--- Number of living units: _L,� Water Supply: Public system E] ;Community system [IPrivate i& Depth to Water Table. _ f}- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑- Sandy Loam Clay Loam ❑ Clay L] Ado Hardpan E] Previous Application Made: Yes [INo X New Construction: Yes,K No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) tQ_.------.M t`riai r Septi Tank: Distance from nearest we� .___ Distan from foundation.-__. _ - X X�i_.__....Li uid de th__-- - - Capacity___1Z __-... No. of compartments------------------------I_Size--__ --------------- 4 Pi Disposal"Field: Distance from nearest well.... ---Distance from foundatio •----- 4C-.-_--.Distance to nearest lot gine---�--_-- o Number of lines__---_tom Length of each line___.___--`�,,�}}_�t__-__.Width of trench__--._ _:.1___________________ �- _De th of filter material----._1_S_----------Total length-------��.�---------------------- Type of filter mat I_. ' p Seepage Pit: Distance to nearest well-------------_-.--___Distance from foundation-_.___..---______.Distance to nearest lot line----------------- Seepage _..___..- -___. ❑ Number of pits Lining material Size: Diameter--------------- -------Depth------------- ------------------- Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-_-_-----_------.---___---___.___els. ❑ Size: Diameter---------------------- -------- ------Depth--------------------------------------------------•-Liquid Capacity-.--------------------------9 Privy: Distance from nearest well-----------------------`------------- ----------Distanci=fiom nearest building--..'----,- ----------------------------- --------------- Distance to nearest lot line --------------------------------------------- ---------- ------•---------- 171 ---------. --- ----- _ ------------- ----------•----------- �t I Remodeling and/or repairing (describe}:___ __ ______- - --------------- ----------•------------------ Lt .. -----------------•----------------------------------------- • --------------- ----------- ----------------------------------------------------•`------------------------------------------------------------------------------------------ I hereby certify that I have preparedthis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of/the San Joaquin Local Health District. Contractor) (Signed) ---------- {Owner nd/or on tactor) --------- B _ Z------ (Title) ------ on -- ---- id_ - ---------- (Plot' -------- (Plot.plan;•showing size of lot,-location.of system in relation.to w.ells,.buildings., etc., can, be placed anjrµverse side). -_ FOR DEPARTMENT USE ONLY /_ 1 _ ---_-- -- W._._.._.-_-....� -_----.A _f- ------------------------------ APPLICATION ACCEPTED`BY:#- = D TE=== ---- --- ----------------------------------------------- REVIEWED BY--------------- ------=---- - n DATE . BUILDING PERMIT ISSUED-------------- -------------- DATE 4 _____________ti___._-._.__________.-.____...__ Alter ion and/or recommendations:. ------ --- --------------- -- ---" ------ ------ - cti--------------,r ------- ` - � - '------------ � --------- -------------------------------------------------------- ----------------------------------------------------------------- -------------------------------------------------------------- Date..- --------------------- -------------- ----------------- . FINAL INSPECTION BY:�_.._�-'_- .- --�.�? -- �.^ -r SAN JOAQUIN LOCAL HEALTH DISTRICT f132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y � orn Stockton, California Lodi Califia Manteca, California Tracy, California '" , ES-9 2M ReVLSed 8-'59 F,P.Co.