12994 - Laserfiche WebLink

Home Browse Search

Permit No. �°z--�-•-`---•� J APPLICATION FOR .SANITATION PERMIT (Complete in Duplicate) Date Issued _-_------.--- 1 �^ This Permit Expires 1 Year Front Date Issued d install the Application is 96re6y made to the San Joaquin Local Health District for a permit to construct an 00kr- Zooscr y This applica ion is made in compliance with County Ordinance No. 549. . M g ,�r. f �� JOB ADDRESS AND LOCATION. -Q1_�A/�'R---- � {'"`� �� -11 Owner's Name-----/y� 5-_.. itlit� - -spr - Address-------��'O X-- �'� .-� l-llx HCl-: � Phone..----•--------------------------- ! Name--- --��-e�L�.R-- -��-- -f�-��-'--------------------------------------------- Contractor's Installation will serve: , Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _3--- Number of bedrooms/0-. Number of baths - Lot size .--- - -------------------------- } Commuriit system ❑ Private [2 Depth to Water Table _ -- ft• f� Water Supply: Public:sys#em ❑ Y Y Adobe Hardpan ❑ Character of soil #o a depth of 3 feet: Sand d Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ ❑ Previous Application Made: Yes F1 No New Construction: Yes � No ❑ FNA/VA: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a~ Septic Tank: Distance from nearest well--._--_----�=D Bance from foundation------------------- Septicdepth Material:.----:-Capacity------ ------- ------ No- of compartments------------ --- - -" r ' stone'from foundation/-E1_-_.------- Distance to nearest lot line--_--- w l Dis Field: �lluma�ee of lines from eares well-?-s __ _Length' of each line-_ --n----------- -- -`O.Width of trench---- Number rench-_- - -------------------- 01 f Type of filter matena4r t,- � =/-Depth of filter material/.- ._-:--_------_Total length_---�' '- fi ' Seepage Pit: Distance to nearest well_----_--_-------__----Distance from foundation--------------------Distance to nearest lot line------__---._--.- Number of pits- Lining material-_r_- -------- -Size: Diameter-------- - ---------Depth-------------- ----------- Cesssppool: Distance from 'nearest well----_--_'------Distance t om foundation_-----------------Lining material...__--- Ca gals. -Liquid acitY _: ❑ Size: Diameter-=------------------------------------Depth------------------------------------------------- tance from nearest [wilding-----------=--------------------- ------- Dis Privy: Distance from nearest well__-------------------------- --__-. ❑ Distance to nearest lot line---------------------------------------------- - ` Remodeling and/or repairing (describe:__fl -------------•----------------------- ---------------------- ------------------------------- -------------------------------------------------- -------- ------------------------ --------------------------- ------------------------------------- ----- - -- � I hereby cerci#y�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. _ ' ., . ' Q�� j- --_ - .(Owner and/or Contractor (Signed) ----------------------------- f/ 4 � -, .- (Title)_-- ACSS/_t?,? --}----- - ---- �c - ----- -- ---------------- ---------------------------------- By: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY - " DATE------ APPLICATION ACCEPTED BY--;A-1_; -------- DATE------------------------------------------------------------ REVIEWED BY ---------------- ------- ------ -------- ----- - ------------ ----- ------------- - - -- ------- - DATE---- ------------------ ------------------ --------------- BUILDINGPERMIT ISSUED--------------------------------------------------------- ---------- = ------------------------- Alterations and/or recommendations------------------------ ---- ------------ ---------------------- ------ --- --- ----------------- --------------------------- ---- Date-- -- -- -------- -------- ------ ------- --- ----- -------- - ------------ /,1V_ FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT � 132 Sycamore Street 814 North "C' Street t30 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M Revised 8 '59 F.P.Co.