19063 - Laserfiche WebLink

Home Browse Search

FOROFFICI: USt: -------------------(r- 3o- ',_ I qq 3 APPLICATION FQR SANITATION PERMIT Permit No. _-�_.l._Q..6.... (Complete in Duplicate) Date issued ------------------------------------------------------- - This Permit Expires 1 Year From Date Issued __-._. ... jq3- 2 O —z� 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 com liance with County Ordinance No. 549. o CO7 s- �,ta T � �` JOB ADDRESS AND L CA710N_ /�yYy'C�/-...I I_. _.a--� ---- ------ ------------------ Owner's Name------ ------- -------------- Phone.- -O.�.. ,/ _ r. r. Address------ r1_ �'1 Ic3 /l� Contractor's Name-----� *_1 --------------- --------------- -------------------------------------------•------------- Phone------ --------•-•---------------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 c� Number of living unitsa-1 K- umber of bedrooms _. ... Number of baths __ Lot size .....................�.�J --------- Water Supply: Public system ❑ Community system ❑ Private [?/Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-....... --.-) No D,--New Construction: Yes ff' No ❑ FHA/VA: Yes ❑ No ❑ O 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....9Pr---Distance from foundation... 0_.-_.__._.Material__ _- X~- [l- No. of compartments.......£�..-_-------r--Size.�0(1kE-X_IO:r.Liqui del? h--- `-.. ------------Capacity._ fll2,io6l:410� Disposal Field: Distance from nearest well.- QQ_i_-_.Distance from fou dation.A�y ...Distance to nearest lot line_ 0" Number of lines--------_.- ..._��q_<<' L,,e�fh of each line_.13.Q- -Width of trench..�25 A.---------_.Type of filter materia . V.11 ^- -IJeph of filter material_-� .-........Total length..'-..-._ -� D.._.. 1 r* Seepage Pit: Distance to nearest well-------_-------------Distance from foundation--------------------Distance to nearest lot line-.--.-.-..-._.... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- 0 � Cesspool: Distance from nearest well.................Distance from foundation... ------_--------Lining material------------------------------------- 0 Size: Diameter- ------------------------------------Depth--------------------- -----------------------------Liquid Capacity---------------------------.gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building----------------..-..._..--.-.-----------. ❑ Distance to nearest lot line------------------------------ --- - ------ ------------------------------------------------ ------------------------------- Remodeling and/or repairing (describe ----------------!�'•4�i1�� gy�pY 'p ---------•-••-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------r - ---------------------------------------------------------------- ----------------------------•------------------------------•------------------------------•-------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, an rules and reg ons the San Joaquin Local Health District. . !o ------- (Signed) - ------- -------------------- ----- ------ ------------------- ------ - (Owner and/or Contractor)✓ By:--------------------------------------- ---------- ---------------------------------------------------------------------------------(Title)---------------------------- - --------- ---- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY ,, APPLICATION ACCEPTED I3Y - ------- ----------------------------------------------- DATE-- .- A,6-------- --- REVIEWEDBY---- ---------------•---•------------------------------ -- -------------------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------- -------------------------------------------------------- -- DATE.------------------------------------------------------------ ` Alterations and/or recommendations:---------- ------------------------------------ -------------------------------------------- ••-------•----------------------------------------------------- ----------------------------- -------------------------- ----------------------------------------------------------------------- - ------------------------------------------------------------ ---------------------- ------- --- ------------------------------------------------------------ ----- --------------------------------------- ------ ------------------------------ ------------------------ ------------- -- - - -------------------- ----- ------------------------ ---------------------------------------- ----------- --------------------------------------------------------- FINAL INSPECTION BY:.._ ±' Date------...! nil-------------------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California