15250 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------------------------------------------- --------- ----------------------- ----- __________________ APPLICATION FOR SANITATION PERMIT Permit No. .. -------------------------------------------------------- (Complete in Duplicate) s1r 7-G-3 .............................. . ---.-----.-.--_ This Permit Expires 1 Year From Date Issued Date issued ..____..............___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desced. This application is made in compliance with County Ordinance No. 549. "ter-r .F3 LDrl LyNW boa JOB ADDRESS AND LOCATION.----- ! _ 1,..--. ----aq---_ 7Sv...1,;Zo- ....... Owners Name--------- -t1__E----- n . . t - -----,----�--------------- ----------------------"-O P1h one------------------------------ Address. ...... + _R.Q_Z- �`"... �� .... I` ' '" ----•-----•-----------------•---------•-•-.... Contractor's Name-fAr- E5-----.__-5J5� --•-- = ----------------------------- Phone.................................. Installation will serve: Residence [Apartm ntl:, House [3Commercial ❑ATrailer'Court ❑;"Motel ❑ Other ❑ Number of living units: j---- Numberoms . . Num er of baths -- Lot size— _ Water Supply: Public system E3 Community sys}em ❑ Private [Depth To,Water-Table"e ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑Clay Loam[lay ElAdobe❑ Hardpan 0,"" ,.. Previous Application Made: (If yes,date____________ __ ___) No [ New Construction: Yes Wr No ❑ FHA/VA: Yes ❑ No Mr" � i TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-_-5 -_Distance from foundation._. _________.Mater-al_co/vf; ��- No. of compartments_____,_ i__�-__-.--Size_, /XX.�---5_,___Liquid depth-_____ ___.`Capacity_1;LP-0._.. Disposal Field: Distance from nearest weil--2:.i;_.._Distance from foundation..../0........Distance to nearest lot line-----5__._._.. .� Number of lines_': - Len th of..eac}reline_______j6Q--------------Width of trench......r2-9./................. Type of filter mateeerial-_- :_.Depthlof filter material �r_.nTotal• length__________6_Q-_-------------------- Seepag Pit: Distance to nearest well-.__.50-_-____Distance from foundation_____ __._..Distance to nearest lot ling._._ _~ Number of pits___--------Lining mate rial._./31_PK:A'5N--Size: Diameter.�/Ye /`V_X.___-Depth_-_10..:..,</........... Cesspool: Distance from nearest well---1-.j--------Distance from foundation-------------------.Lining material..................................... ❑ Size: Diameter.---.1c - 1_1.. -----Depth-------------------•---------- --------------------Liquid Capacity--------------------------- Privy: Distance from nearest well._---- ---------------------------------------Distance from nearest building---------------------------.---_----__--- ❑ Distance to nearest lot line.___ ___________________________________________ Remodeling and/or repairing (describe):--- - .--s - ------- -----W-A.15-------/ _C1.1. , ----------------------- ..-----..... ----A!A45------AR1b-----v0(>T__.o&.TN-----4.7-----Ate......='ZMP---1;974�� ----�-R ----y-------------------------------------------------------------- - 1 r --- - - -- -- -------------------------------------------------------- I hereby cerfif hat I hay d this a,pplic #ion and that the work will be donein accordance with San Joaquin County ordinances, State s, an les a r' ulatio of +he San Joaquin Local Health District. 4 (Signed)------ ---- -----`---- --- - ------ -- -- -- ------------=•------------------------------------•-------------------(Owner and/or Contra s+or By:--------------------------------------------- - -1-_ --. (Title)----------V ------------------------------ ---------------- (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 BY ' . = DATE r�� REVIEWED BY - - � - --- DATE-_---------------- ---- BUILDING PERMIT ISSUED.................... ---••----------------- -----------•--------------------------------------- DATE----------------------------------- --------- --------------- Alterations and/or recommendations:----j------------------------------------------------------------------- ............................. -------------------------------------------------------- -------------------------------------------------------------------I--•-------------------------------------------------------------•-----------------------------•---•--------------------•-••------------------------------- -------------•---------------------- ................. ._.... ... FINAL INSPECT] ` Date------ { - ------------ ----------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sireet 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California ES 9 REVISED 5-59 2M 5-62 ATLAS -