16820 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' --------------I------ -- -------------------------------- APPLICATION FOR SANITATION -PERMIT Permit No. ... ... . .....r -C� (Complete in Duplicate) Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San JoaquiniLocal 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 LOCATION R 'OkQQ_.!_..A- _- eR e5� 'r1_ Owner's Name------------ -JOF----------13E�yM-i�-0---------------------- ----------- - - - ----- -------------------------------- Phone-------------------------------- Address------------------_-yj y...�" !_r!_��C • ----------------•-•-•- Contractor's Name_/Y1ArqT_ ---•_ -------------------------------------------------- Phone------.-------- ------------------- x. Installation will serve: Residence •❑' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___i___ Number of-bedrooms __ Number of bath',X_ __ Lot size __._� -�__ ___� ______________ Water Supply: Public system ❑ Community system ❑ Private [/Depth tomo Water Table 3--- ft. Character of soil to a depth of 3 feet: Sand 0' Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Cif yes,dote--------------------) No E<New11C1*onstruction: Yes 2;�`No ❑ FHA/VA: Yes ❑ No E� TYPE'OF INSTALLATION AND SPECIFICATF0__` {f a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic T nk: Distance from nearest well--,��__ Disfan from founclation__ t:r------ --Material_. g+ l _ h_____.. No. of compartments_____�--____._._.---Size__b.�X9_X S.Liquid dept�---- _ - Capacity__--� ---------------- Disposal Field: Distance from nearest wel1.•.7____ Distance�fror"n founda''ti n'�J ""''"`Di"stance to nearest lot line_.__��T. - f• 6t Number of lines--------__�--a.�___________________-fLength of each line__'- _' Width of french- ___-- ____.__ Type of filter material__ __ Depth of filtermate�ial"f `` `_Totallength_______._ _____f______________ Seepage Pit: Distance to nearest well_ ___....____ Distance from foundation________________-_.Distance to nearest lot line-------_.-------- 'J ❑ Number of pits._..__________ Lining material----------_____-------_Size: Diameter---_-------- ._ Depth Cesspool: Distance from nearest we' fll_ _.______bistance from foundation____________________Liningrmaterial---------------------__ ___ .___. r Size: Diameter---------------- 9 """"r- f # ❑ -- ------------- Depth--------------- --=- -=�------------Liquid Capacity -----------------------gals. Privy: _ Distance from nearest well .__.----- -- - _____ _________Distancejf om;nearest,build,ing____.______-.--_---______________..____._.�, [❑ Distance to nearest lot kne----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/oi repairing((describe]: ... --. _-------------- ------------------------------------------ -- - '�--------------= ------ ------------ ------------------------ ._. + -----------------8----------------..-------------------------------------------------------------------------------------------- I. to ---•-----------•------------------------------------------------------------------ ---------------------•-------- ------ ----------------------- 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. t —(Signed)- - • -----=------------------- .------ - ----=---- --- -------------------------------------------=---- -=--(Owner-and/or Contractor)_ _• By: e fi1, - � (Title) --------------------- - -- - (Plot plan, showing size of lot, location of system in relation to wells buildings, etc., can be placed on reverse side). �II,s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -- ----1- ,-O------------------------------------------------------------------ DATE-----,/-- REVIEWEDBY---------------------- ----- - ---------------------------------------------------------- DATE------------------------------------------------------------ BUILDLNG.,.PERMIT,...ISSUED --=------ =-= — :=:.BATE=a_.�_ _ -,�---------------------------- . - �. Alterations and/or rec�"""`"ommendations:._____.._-_:_._._ - t�3e " ►�e +_3 Ot 3. •. - r FINAL INSPECTION Date_____________ _'.. ` _ l __.__. . -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California ES 9 REVISED 13-59 3M 3-'63 F.P.CC. J