10953 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit . , (Complete in Duplicate) ---Date Issued _�{�_ _=-I"�l . 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 Ordin nce'No. 549. JOB ADDRESS AND LOCATION.. (� - v ?n=Cr✓.------•-=,_��---------------�----�'--�---------------------------- Owner's Name 8_� 1� I S.LtAq -------- Phone.-_C_ 74"1 Address-----------=------------ -- S alky\_c� --------------------------- Contractor's Name--------------------------------- 7---- ---------•----- ---=--------- - -------------------------------------- Phone---------------------------------- Installation will serve: Residence [] �,Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_____ Number of bedrooms -------- Number of baths -------- Lot size ----------------L-------------.-_-_______._______________ Water Supply: Public system ❑ Commun' system ❑ ;�rivate� Depth to Water Table fS__ ft. Character of soil to a depth of 3 feet: Sand � Gravel E] Sandy Loam El Clay Loam [3 Clay ❑ Adobe Hardpan G—' Previous Application Made:_Yes Ef"'No ❑ N w- onstiuctio - Yes No FHA VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:?. - w (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material--------------------------.---------------------- El _____-_ _-------____.❑ No. of compartments-------------------_____Size--------------------------------Liquid depth------- Capacity--'--------------------� . Disposal 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 material-----------------------Total length------------------------- _-- ------ �ee}�aw�e-�Pi Distancl to nearest well____,, (____ Distance from foundation____:.l-.1-__�Dis Distance to.nearest lot Iine___J~_______ StAm Numbe i of pits___-�________________Lining material___ ------Size: Diameter____V___. C.._j____Deiath----. (.-.�a________________._ Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material -------_._-------___________--______. ❑ Size: Dii me'ter---------------------------------------Depth-------------------------------._ .------ --------Liquid Capacity----------------------------gals. k Privy: Distance from nearest well__________ ____________________.___________._Distance` from-nearest'building------------------------------------------ ❑ Distance to.nearest lot line --------------------------------------------------------------- Remode4ing and/or r pairi g (descri )----- tA ---•-• -X4_11'w1 U- C - ---- ---------------------------------------- - -- ----------------------- ----------------------- -------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ Ihereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County ordinance ,1 St # laws rules I re lations of the San Joaquin Local Health District. I. [Signed) - ------ - - -------------------------------------------------------------------------------(Owner and/or Contractor) y: --- ------------------------ ------------------------- -----------------(Title)-------------- -- -------------------------------------------- (Plot plan, shodi4'siie of,lot,;location of system in.relation to wells, buildings, etc., can be placed on reverse side). j. t :1) f FOR DEPARTMENT USE ONLY APPLICATION jXCCEPTED BY----- -i --------------------- ---------------------------------------- DATE--------- & - - 1------ REVIEWED -BY------------------------------------------------- --------------- ------------------------------------------------------ DATE---------------=------------------------------------------ BUILDINGPERMIT ISSUED------------#----------------------------------------------.------------------------------------------ DATE----------------------- Alterations and/or recommendatio s--------=-------------- - -------- f------. -•-"--------•-•------------------------- I ---- -- - %--------- r ---------------------------------------------- ----------------------------------------------- -----------------------------------------------------------=-------------- ---------------------------------------------------------------------------------------------- , FINAL INSPECTION BY: Date �✓ - C S7 FINAL JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California f Lodi, California Manteca, California Tracy, California I ES-9---2M Revised 3-57 FRCO.: