12519 - Laserfiche WebLink

Home Browse Search

r , APPLICATION FOR SANITATION PERMIT Permit No. ._!_. _.5...1.r_ /elf-3d (Complete in Duplicate) Date Issued ...�L -� t'0., � This Permit Expires 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 rclinance 5 JOB ADDRESS AND LOCATI --- --------------fonOwne'r's Name------------------ •---�-• = ---Q------••-•---_ ��.��--•---------------------------------------- ------ ......_.--- Address----------_------------ -- ---------- ---•-- r=---- � - � .A ------- f _... Contractor's Name ` ------------- Phon -.. --- --._R.... -p17 Installation will serve: Residenc�Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - -____ Number of bedrooms A' Number of baths _��___ Lot size _/ 0_1<...n-�_Q-------_----------------- Wateiir Supply: Public system ❑ Community system ❑ "FPrivate�Depth to Water Table¢.57 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'Loam ❑ Clay Loam ❑ Clay ❑ Adobejz Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E] NO FHA/VA: Yes ❑ No r TYPES OFINSTALLATIOWAND SPECIFICATIONS: I. (No septic tank or cesspool permitted if public sewer is avaita�bbl within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-----------------._.Materia!_-----..______._______._____________..____--____. is tiN( No. of compartments------------- ------- Size--:-----------------------------Liquid depth-------------------------. Capacity----------------------- Dispd.sal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line__________-_____. Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------•------------------ �, Type of filter material-------------------------Depth of filter 11aterial----------------------- length------------------------------------------ e _ Seepage Pit: Distance" to nearest well__�______ Distance from foundation___��___-�--------..Distance to nearest lot line--- X__ k Number of pits_- Lining material__- ---.Size: DiameterAft4-33---Depth-_, ----------------- 5 y Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------- -_.___. 1 Size: Diameter--------------------------------------Depth----------------------- ----------------------------Liquid Capacity-. ------------------------gals. Privy' Distance from nearest well_____________________________-------------------Distance from nearest building--------------------- ------------------- Distance to nearest lot line ---- ----------------------- ---------------- ------------ ---------------------7 �s Remodeling and/or repairing (describe):---------� ---------- ------ ----- --------- d --------- ---------------- --- -------------- --------------•----------------- ----------- _ ' ------n- — - ---- ---------- �r ---------•----------------------------------------•-•-------------------•---------------•----------------------------------------------••------------------------------ --- I Il # r ---- ---------- ------------------------------------------------------------------------------------------------------------------------------------ ! hereby certify that I have prepared thi cation and thatthe wor ill be done in accordance with San Joaquin County ordinances, State laws, an les dreg ions the S Joa uin Lo ealth District. -- ------ ------ -- ----- ---------------- -- Owner and/or Contractor [Signed} ( / n iBy:------------------ ---------------(Title) �------------- ---- ------------------- (Plot�plan, showing size of lot, location of system in relation o wells, buildings, etc., can be pid on reverse side]. R-DEPARTMENT-USE ONLY APPLICATION ACCEPTED (3Y____________ __ -- DATE___-- ----- _- _ C�_-________-_---- REVIEWEDBY----------------------------------------- --------- - ------------------------ ---------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT-ISSUED---------------- --------_a ------------------------ DATE------------------------------------------------------------ Alterationsand/or recommendations------------------------ ---------- ----------------•-•---------------------------------------•----------•--------------•--------------------------------------- -- ----- - ------------------------------------------------------------------------------------------- �_-. ---- -------------- - --- ---- ff �o l�coo ,Ud,45 �. yp - --------- L ?14 ------------------- i FINAL INSPECTION BY: i7�('/G� __ ._. Date - ......... ��'' i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i4 • •+2 ES-9=2M l2evlsed 8-'59 F.P.Co. s"