11412 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ___.&Yl_Z_ (Complete in Duplicate) Date Issued .__"11 54- .-_ `"'► This Permit Ex fres 1 Year From 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. I JOB ADDRESS AND LOCATION ----------- :f q I�-_- Owner's Name --------- --------- i-----rL- _fl- rJ Phone-.._.._-... -------'- ---------------- ------------------------------------ 4--co --- Address------------------•--•-------•----------------------------------------------------------------------------------------------------•----------_--.-----------•--....------------- Contractor's Name---- �� _ t ulzil� /�`j c�' '-•----------••_.---.-- Phone ................................... Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ _ ._ Number of bedrooms _ Number of baths 3---- Lot size _ _l _ ___ Water Supply: Public system E]Community system ElPrivate I: Depth to Water Table--'__`� ft. y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ? Sandy Loam ❑ Clay.Loam-�9, Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes E] N0 New Construction: Yes No-E]PMA/VA: Yes X, No ❑ 4 ; TYPE OF INSTALLATION AND SPECIFICAT_ IONS: 341 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _____°--------- Distancerfrom foundation -----/C-------. Materiaf ---- ------ '------'---------------- ----------- No. of compartments �-----------------Size:_- _ X_. -------- Liquid depth _-.----41 -.----- Capacity ----_- ...... Disposal Field: D'rsta'nce from nearest wail__ -- -__.._Distance from foundation-------.� Q -_--_ Distance to nearest lot line ................. Number'of lines --------- `?--------------------- Length of each line --------- 7._l- ------------ Width of trench.---------- -`ir Type of filter .material-_ --- Depth of filter material ------_-A? ----- --Total length-------------- --------------- . Seepage Pit: Distance to nearest well ----------------------- Distance from•foundation-------------------- Distance to nearest lot line--. ----------- ❑ Number of pits------------` .------ Lining material------ �'_1--- -------- Size: Dia.meter---------------------- Depth --------------------------------- Cesspool: Distance from nearest•well----------------- Distance_ from - foundation----.- "'Lining material----._-----__--_-_----.-----_-----. Size: Diameter------------- - Depth ' -..----_--__ '-Liquid Capacity_ -------------------------- gals. Privy: Distance from nearest welly------------ ---------_; _ --------------Distance from nearest building----.---_-.-_---------__----.--..----. ❑ Distance to nearest lot linle ---------------------------------------------------------------------- Remodeling and/or repairing (describe)------ -------- I* -------------------- •------------------------------------------------------ l jh --•-------------•----------•----------•-----------------------------------------•-----------------------•------------------------------------------------------------------------------------------------------------ -- ------------------- hereby certify th`'at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ruregulations of he San Joaquin Local Health District. (Signed)t ---:-(Owner and/or Contractor) Y= ----------------.-------------------------------------------------------------------------------------------------------------(Title)-------------------------------------- --- ` --- ------- (Plot-plan, showing. size{.of..lot, location of system in relation.,to wells,ibuildings, etc., can be placed on reverse side). FOR DEPARTMENT !USE ONLY_ - --;, APPLICATION ACCEPTED BY ----------------------- ----------- DATE REVIEWED BY ------------- ---- `�/ --� - --- --- - ----�------�------------------------------------------------------------------------------------ ----- DATE--------------- ---------- ----- BUILDING PERMIT ISSUED---------------------------_ -------------- DArTE----------------- ---------------------------------------------------- -------------------------------------------- Alterations and/or recommendations-------- ------ ---------------------------------------------------------I---------------•-------------------------------------•------------------------------- ----------------------------------- ------------------------------------ - - ---------------- ------------ --------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_.,A41-1.2 _-------- -------I Date--.--�o-Q.-- SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+cckton, California Lodi, California Manteca, California Tracy, California ES -9-2M Rcvlsed 8-'59 F.P.Co.