11982 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit �� b (Corn late in Duplicate) � l 1 P P � Date issued /_______.�&-_--- � 1 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. I This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION--------- I-B-------�--+....0- _Lv------------------------------------------------------------------------------ ---------------------- �1___�-12� _ Phone------------------------------------ Owner s Name----------- ----mss- - � ----•-•-------- •---- Address -----------•---------------------------------------------------- - Q- Ur... �l..t?. Contractor's Name � -�iL�,1 ----Z Y / If Installation will serve: Residence gsApartment House ❑ Commercial L] Trailer Court ❑ Motel ❑ Other ❑ 01 Number of living units: __ ___ Number of bedrooms%3---- Number of baths _-/2,L•ot size ------------------- Water Supply: Public system P-_116system ❑ Private ❑ Depth to Water Table -14ft. Character of soil to a depth of 3 feet: Sand.E], Gravel ❑ Sandy Loam Clay Loam ❑ Cla��No bbe Hardpan ❑ tion Made: Yes No ,�, New Construction: Yes.0�7o❑ FHA/VA: Yes ❑ Previous Apphca ❑ L'T I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ -----------Distance from foundation_ /d-___f__--Material__ �?_t k�- - _------------------- t No. of compartments------a;---------------Size_._,S:'4_,.Yt1-_--------Liquid depth---Yfs-______--------Capacity---- ---------------.. Disposal F• Distance from nearest well,.----- from foundation.l_5?.-----------Distance to nearest lot line__________.. Number of lines------xQ------------------------Length of each line------~JS---�-----------.Width of trench.�.��!-.--------------------- _ Type of filter mate --------Depth of filter material----._I__f(_«-------Total length----.I-S-0---------------------------- 04 Seepage Pit: Distance to nearest well____' ---------Distance from foundatison---f_G'_r......Distance to nearest lot lin�,5_/______ [ ' Number of pits.----? ---.-------Lining material---7-a _k'-- --Size: Diameter.-_33.- ------Depth-----rs�.S_------------------ Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material-----------.___.----________-____.__. ❑ Size: Diameter•-------------------------------------Depth--------.--------------------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-------------------------------------------- =Distance from nearest building-------.--------------------------:_---.-. -� ❑ Distance to nearest lot line------------------------ ------------------------------------------------------------ -- 6 Remodeling and/or repairing (describe)----------------- -------- -------------- ----------------------- --------------------------------•--------------------------------------------------•--------------••------------------------------------- -------------•------••----•------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ________________(Owner and/or Contractor) -------• --- � - s �L.. ;may, ��, g -:- „.a�/L�L — (Title) e` -'_f`..`”' - (Plot plan, showing size of I catio of system in relation to wells, bu ' gs, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- -- --- ---------- ---------------------------------------- DATE------ter f Gr'�---------------------------- REVIEWEDBY----------------------------- - ----- ------------ DATE---------------- ------------------------------------------ BUILDING PERMIT ISSUED------------------------- --------------------------- DATE Alterations and/or recommendations------------------------------------------------ ---------•--------------------------------------------•-------•-------------------- ----- --- --------- ---- - -- - ------ --- I "I ------------------,� ��a�---��- --- FINAL INSPECTION BY•------- --------- ---- ----- -----•--------------- Date------- � 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.