12308 - Laserfiche WebLink

Home Browse Search

_ r APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplica+e) This Permit l x fres 1 Year O/Z�J- This Application is hereby made to the San Joaquin Local Health District for a From Date Issued Date Issuedpermit to construct and install the work herein describedapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...---- Owner s. OCATION.__.___Owner's Name---- -�. �._ � --------"---•---------• Address_.--- -- - • - ----- Phone ------------------------------ - ------- - - - Contractor's Name__. � - --•-- Phone-----• Installation will serve: Residence ❑ Apartment House Commercial Number of living units: Number of bedrooms ___3" El Trailer Court E] Motel E] Other ❑ Number of baths _.?__ Lot size Water Supply: Public system F`Communitysystem Y stem ❑ Private ❑ Depth to Wafter Table _�+S{t• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamCla Previous Application Made: Yes N ❑ Y C1 Adobe( HardAan C]❑ o u New Construct Yes FHA/VA: Yes [] No TYPE OF OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest :. w_el_I- ®" Distance rom fou--ndationfg-fjf MNo. of compartments.--. i ___ _ Fr _ a ------- ize- � --- ._Liquid depth----'fC--- ----- --- --- Capacity.l�Oa� _� Disposal Field: Distance from nearest well_._---"---.Distance from foundation.-_ " h-> ( -_-_____. Distance to nearest lot line____.*-+_""!___ Number of lines__- ' Length of each line___7.5"''_ ______"-- - Width of trench-.2 Type of filter material_" vE _ Depth of filter material/Jr.' See aTotal length .�;,•.,._ Seepage Pit: Distance #o nearest welL_�k�_ Distance from foundation_,�A�"_ � ' _.Distance to nearest lot line_________ r Number of pits.____ c ------ Lining material' *C/ _ Size: Diameter-__ � " Cesspool: - --- Depth 2a" ❑p Distance from nearest well--- Distance from foundation---_________________Lining material_.._____ _-______- .........". Size, Diameter____. _ Depth — ............Liquid Capacity----- .-gals. \ Privy: Distance from nearest well__ _ _ " ----------_-__._"Distance from nearest buildin ❑ Distance to nearest lot line- ------ --------------- - g-- ------- ------- --------------- - ---� � � Remodeling and/or repairing (describe)____________________ Q I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancej51aws, and rules and regulations of the San Joaquin Local Health District. (Signed) (Owner and/or Contractor] (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED �_ -- l _ �y 1cr- BY-------"----- ---------------- - -- - --- ------------------------- DATE---- REVIEWED •------- - � BUILDING PERMIT ISSUED-------•-___" -- DATE-------------_"-__."_ -------- ------------------- ---------- ------ D Alterations and/or recommend +ions ATE. ------ -��-`�-8------- - � --Z 9 -- ...,,,,[((------------------------- ----222,,, -- __.._..-------------- /�Zc„v2 � ------- ------------- ------------ INSPECTION' FINAL INSPECTION BY J / r ate C1 f ✓ LP ------ SAN -__-SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Sfreet Stock+an, California ' 814 North "C' Street Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.p.Co.