16970 - Laserfiche WebLink

Home Browse Search

—RD-R-OFFICE USE: )0 /,,1 =0 --------------------------------- --------------------- (,� --------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. .��_. ------•---------------------------- ------------ (Complete in Duplicate) Date issued ... - -------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 cA plia a with County Ordinance No. 549.E '� R 1<s RD� ^'I a n1 JOB ADDRESS AND LOCATION•• d -------6--0-77--------_R_J_p°tY----------------------------•------------------------------------------------ L - Owner's Name..------C(I_l Y �'-•--------•--- Phone rf9__.��.X4.0. ...... Address------------ JcM�' D v --------------------------------- ------------------ Contractor's Name...__ t.. !. /�7 r1 -----� -�r---�' `a a Phone.?! .� 9- i J. Installation will serve: Residence r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___. Number of bedrooms _2__- Number of baths �L_._ Lot size ..... ......... ------- Water Supply: Public system ❑ Community system ❑ Private 0- Depth to Water Table o-!2_ 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 New Construction: Yes gi No ❑ FHA/VA: Yes ❑ No 19 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---_•_�!ftDistance from foundation-40/t_ rCot4!G7!CT7a No. of compartments_.-_---.._s�-----------size------�/__X_X_/�7'Liquid depth---------el�'`----- Disposal Field: Distance from nearest well------ bDistance from foundation__/f� _ ________Distance to nearest lot Number of lines_-.. _`—_____ Length of each line ______ _______(_,_Width of trench' -0- ' .......2 .�! Type of filter material_4(___� ____Depth of filter material......irate+. _Total length__________-- Seepage it: Distance to nearest well____,57P----------Distance from foundation___1.0----------Distance to nearest lot line.... .....- C Number of pits-----I---------------Lining material-R0-C,. Size: Dianae#erv5.K3--•--•-- Depth___._f_;_�_�-__.-.--------.._ N Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------- . ❑ Size: Diameter-------------------------------------Depth--------------------------------___-------•-----Liquid Capacity............................gals. Privy: Distance from nearest well-----------_--------------------------------------Distance from nearest building____________________-_---_----_-----__---. �y ❑ Distance to nearest lot line------------------------------------------------------------------------.......-----------------------------------------•---•--------------- . Remodeling and/or repairing (describe) -------`� -��------_ ----------- C ---_--.-.--•----- 5 1— -=---------------- . -------------------------- ------•---------------------------•-----------------------•----------------------------------------------•-------------------------------••---------------------I----------------------------------------------------------- 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 San Joaquin Local Health District. (Signed)...... ' (Owner end/or Contractor) By:-----. -• - ----- -------------------------------------------------------------------------------(Title)---- cC�" --------------------------- (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY DATE----- APPLICATION ACCEPTED BY------- .-- -- -----------------------------�`--------------------------------------- REVIEWEDBY--------------------------------------------- -------------------- ----------------------------------------------------------- DATE----------------------------------------------------- BUILDING PERMIT ISSUED--------------------- - DATE---------•---- ------------------------------•........ Alterations and/or recommendations:---- /7T �r- - 7 � ------ ---.-- - -----. f�_1 j` Com. •---------- •, ----.... •---• ------------------------•-------------------------.---..--------------------•-•----------------------------- ----•---------------------------•----- ..-- --..�..•. ___ ------------------------------------ ------------------------- ------------------------------------------•-- --------------------..------------- ------------------------------- --- --•--/ -�--- ------------------•--•---- ------.-------------------------•---------------------------------------- _ FINAL INSPECTION �._ ZrJ r� Date---------- ------ ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 206 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California SS 9 REVISED 0-59 7M b-61 ATLAS