12805 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .. .y ' {Complete in Duplicate) ____ __ _ 4e./ This Permit Expires 1 Year From Date Issued bate Issued � Z2�(a_l'749 -! 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. JOB ADDRESS AND LOCATIO �_-_ '�`, ,1 �r�-t•!_ l '� '7Lr __ __ _ __ S. Owner's Name--------------------------V""�" - -------a� �• .�--- --- Phone-------------------.. Address -- ---------------- ----•---- y ------- Contractor's Name------------- r��-------��l -- -- ------ --•-- P one--------------------------- - -� -•---- - Installation will serve: Residence [�Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __�- -Number-of.,bedrooms-3---- Number of baths _1 Lot size _Z42_0----X_.2. Q------------------------- Wafer -----------------------Water Supply: Public system Q Community sys ❑ Private �pth o Water Table/I-- ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam ❑ lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yesl❑ - No G9-"-New Construction: Yes ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND�SPECIFICATIONS: (No septic tank or cesspool permitted if publicasewer is available within 20 feet.) Septic Tank: Distance from'nearest well_5AeTw'0istance from fourdatio'n�_/Q_:7!T!!''"_`.'.Mata�aL_____ e—r-'4'��---_____--.. 0 VflNo. of compartments�ments_..._-�-_�__�_____,5ize_ a f _�.____.___Liquid depth__,:_. _______________Capacify_1e 4P�-.. Disposal Field: Distance from nearest welL_� '.'*1� istarice from foundation-!d-,--el4*--Distance to nearest lot line---- 1. __- ® Number of line$----------- _____.___Length of each line_____ _0_�_______________Width of trench..._, _} _r-________.._________ Type of filter material___,5t_ ___ .Depth of filtertmate�idl-4—if��_____..Total length------ " ____.__ f? Seepage Pit: Distance to nearest well__/&? istance from fou S1Ze Di"stance'to nearest lot line---•________._- r r�,anon (4*X L.- -De th---�-------------------------- IN Number of pitsl___"_,�_--- Lining material___Fse..a_C.___ _ _ p Cesspool: Distance from nearest well-----------------Distancelfrom foundation--------------------CLning material r__.________-____________-___ ❑ Size: Diameter_-----------------------------------Depth---- -------------------------------- --------------Liquid Capacity- --------------------------gals. r Privy: Distance from nearest well________________#-----------------Distance from nearsuilding_"___-"_______.___-" ----------------- ❑ Distance to nearest lot line-- ----- -------------------------------------------------------------------------==--- --------------------------- -•--.------------- Remodeling and/or repairing (describe)-----------------------------------------------------------------------------------------------------. -------------------•------------------------- --------------------------------------------------------------------------•-------------------------------•--•---•--•---------•-------------------------•----------------------=---•---------------------------------------- ------•-------•------------------------ d I hereby certify that I have prepared_this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)___ � _ _ (Owner and/or Contractor) . --------------------------------- ------ ------------------------------------------------------------------------------------------ --- ----------------- By:-------------------------------------------------------------------------------------- -----------------------------------------(Title)--------------------------------- -----.._..- -- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR� EPARTMENT USE ONLY APPLICATION..ACCEPTED BY ---- ` ------------- - ---- ------------ DATE ` f-:--�+. REVIEWED BY �mss.__-- ----'--- ----------------------------------------------------- DATE j J/- '-'-�---------------- -------------------- -�["----- a 11 BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------- ----------------------------------------- Alterations and/or recommendations:--------------------------------------------- ---------------------------•--------------------------•-------------•--------•---------------------------------- -------------------- ----------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- #41K FINAL .INSPECTION BY:. - Date-------- t -� /------------------ -------- 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 ES-9-2M Revised 8-'59 F,P.Co. I