7419 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ---I------ ............ gA Dafe Issued A -�ion is hereby made to the Son Joaquin Local Health District for a Permit to construct and install the work herein described, plica 's application is made in compliance with County Ordinance No. 549. 4 JOB ADDRESS AND LOCATION---,Py--7 �� A.10_5� ------------------------------------- Owner's Name------- �------------ vw ------------------------------------------ -C---- ---/ Phone.. ----------- ' Address. A, ---------- - ---- --------------------------------------- ---------- • -1------ ---------C_,,5_A,1'E971f--------------------------I--------------------- ------------------------*---------------------------------------------------- Contractor's Name--- - ------------------------------------------ -----------------•--- Phone------ Installation will serve: Residence E?—Xp_arfmenf House E] Commercial El Trailer Court' [] Motel 0-1,4,Other- - -_E❑ -]................. Number of living units: -------- Number of bedrooms Number of baths . . I/ I Lot size 7 _x /k 0 0 --------------I-------- Wafer Supply: Public system 9?_�C_ommunify system E] Private I Depth to Wafer Table X_9 ft. Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam Ej Clay Loam E] Clay E3 )�do' b a rclpa r. Previous Application Made: Yes El No ED,--New Construction: Yes El No a]-, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 206 feet.) Septic Tank: Distance from nearest well--_-------------Distance from foundation------------- -----Material------ 4 -------- ------------ No. of compartments_"___.._-_"._----------- ---- Jze-------------------------- -----Liquid depth� --- --------------- Disposal Field: Distance from nearest well -------- ------------- --Capacity----------------------- --------------- Distance from foundation------ �j 0 15,4 1A V Number of lines --------------Distance to nearest lot line----------------- ----Length of each line-----_----- -- Width of french Type of filfer material T ------Depth of filter material.._..-- -----_--------Total length------------------------------------ Seepage Pit: Distance to nearest well_.Ar -----Distance from founciafion---..,--t-g�--"-.Disfan Number of pits------/__---- Lining ce to nearest lot line_ ----------- Cesspool- Size: Diamefer__,_,�----------Depth......;��_/----- -- -------- D;sfance from nearest well------------- Distance,f ror�"foundation -------- - -------Lining material--.-_-.--"--_-.----.__Size. Privy: Distance from nearest well.__--_"--------_---,__- -------.Depth------------------------------------------- ------Liquid Capacity---------------------------gals. ---------- _-_-------Distance from nearest bu0d;ng------- El Distance to nearest lot line ----------------------------------- //• --------------- -----s__- --------------------------------- Remodeling and/or repairing (describe):--------- Lf"74 C p -------------------- ------------------------ -------------------- -------- -----------i------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------- ------------------------------------- --------------------------------------------- ---------------------------------------------------------m_------------ ---------------------------------------------------------------------------------------------------------------- -------------------*---------*-------------------------I -- - --- ------- - - - ---- ordinance t the work will be done in accord`a'6cewith_*San.-Joaquin-_County . I hereby certify that I have prepared this application and that----------------------------*_ - - s, Stat aws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ (0" ner and/or C&4'racfor) By:.... (Plot plan, sl of lot; Iocaf ---showing size�o a- -------- ...... s, buildings, ett., can be aced on reverse side).,, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-._"....___'"--_ - --- ---- ------------------ ----------------------------- REVIEWED BY ------- ... DATE------ - ----------- -- BUILDING -- - --- - --- - ------------------------------------------- -- ------ DATE BUILDING PERMIT ISSUED -------------------------------- -------- --------- ------------------------_-------------------------------- DATE -.::51 Alterations and/or recommendations: --------------------------------- ----------------------------------------------------------- KS - ----------------------------------- ------------ ------ ------------------------------ ------------ ---------------- ----------------------------------------------------- -------------------------------------------- ---- ----------------------------- ----------------------- ------4----------- ---------------------L------------- ---- -------------------- -- -------------------------------------------------------------------------------------------------------- 4 0 --------- --------------------- ------------------ ---------------I---- ----------------------------------------------------- .......... ------------ ----------- -------- ------------------------------- ---------......... ----------------- ------ -------- ------------------ --------------------------------------- --------------------- FINAL INSPECTION BY:........ .... ..... Date------- ---------•• ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California $14 North "C" Street Lodi. California Manteca, California Tracy, California E5-9-2M 14S446 A'FWMaD 12-54