18360 - Laserfiche WebLink

Home Browse Search

' FOR OFFICE USE: ------------------------------------------- -------ll-- ________________ ------------------------------'I_I' APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------- I� (Complete in Duplicate) Date Issued ___11,17 ---j-7 f /�� 7 This Permit Expires i Year From Date Issued ' Application is hereby madeufo the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in :'ompliance with County Ordinance No. 549 JOB ADDRESS AN OC'ATION.- _ V4&--et - _ ------------•--------------- . Owner's NamA----- ��-----`-'�_r ---------------- Phone__Y" ---------- '_ ylo Address . ` Contractor's Name---------- -11 Phone /r/L If - ------ - - ------ --- --------- - - -------- Installation will serve: Residence E] Apartment House Commercial E] Trailer Court E] Motel E] Other El�Il' f Number of livingunits: _ Number of bedrooms __d--�y_ Number of baths __ Lot size _ 4_ �� 3- -- Water Supply: Public systelm Community system ❑ Private ❑ Depth to Water Table taZft. Character of soil to a depth_of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made. yes,date----------- No� Ne%G Construction: Yes)K No ElFNA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic-tank.or,.cesspool.permitted-if. ub[ic_sewer,is_available.within,200-feet.) Tank: Distant Ii from nearest well . _ ___ Distance from foundation-_-. - Material ______ ------------------------ Septic ___. No. of compartments_____. --------------Size_y� /,_Liquid depth._._4/_`_.--_---:---Capacity_�0-Z��dJ Disposal Field: Distance nearest well. _ � // � pDistance from foundation. -�-______.Distance to nearest lot line__/Q__.__... Number, of lines_____ ____________ ______ __ _Length of each line_g _ _ '� .I r� - - 9 �--�.�---��.--Width of trench------'�--- - ------------ - Type od filter materiaf__5!c;r �► Depth of filter material____-Q______.Total length________________ _� r r Seepage Pit: Distance to nearest well------_-----_________Distance from foundation______________-___-Distance to nearest lot line____-- g-© ❑ Number! of pits----------------------Lining material-----=.---- -Size: Diameter---------------.------ Depth------------------------- 11; Cesspool: Distance from nearest well----------------- from foundation,----.-----------.-Lining material_______....____________ W ------------- ❑ Size: Diamefer------ -------------- -°-------------.Depth--------------------- ----------------------------Liquid Capacity- -------------------------gals. W Privy: Distance from nearest well--------------------------------------__---------Distance: from nearest building.____.------------------------.--- ---- _. I ❑ Distance:fo nearest lot line--------- 0 - ------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe:---(M-f N-------461T --�(��.----SiARJ1/�C�---��-�----��-�JS� Q F /T .__Stitt/�R_S-------W171 /- H_RS---�SH,1`5 � s -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws ..ave 'rules and reg lations of the San Jo quip Local Health District. (Signed)---- --- ----- ---------------------- ----------(Owner and/or Contractor} --- -- - ---- - - --- - - - � � BY; !I L ------ -----(Title} �e_,e7,�_;ide)_ . (Plot plan, showing size of Io�i, location of system in retail #o wells, buildings, etc., can be placed o . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- R-0_--------------_----------------- ------------ -:----------.-----------._ DATE------/----5_-_4J�_.- ----------- --- REVIEWED BY ------ --9 Vi,-1------------------------------ ------------------------------- DATE f "� �f��A------------------- BUILDING PERMIT ISSUED.I�'---------- ------------- --------- ------ - ----------- DATE- - Alterations and/or recommA dations------------------------------ -------- ------- ---------------------------------- - --------------------------------------------:1-1---------------------------------------------- -- ----------------------•-------------------- ----------------------------------------------------------------------------- ------- ----- ------- -------------- - ----- ---------------•-----------•- -------------------------------------------------------------------------------- -------------------------- ---------------------------------------- ....... ---- ----- --------------- - ---------------------------------- --- - --- ---- - -----•--- -- -- - ------------------------------------ FINAL INSPECT N BY:1111 -- - - - -------- Date------------- 01``� --- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.``P.C a.