11779 - Laserfiche WebLink

Home Browse Search

10V t LA G// APPLICATION FOR SANITATION PERMIT Permit No.._��.7�. _.... (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued __3I_4. Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta►I the work herein described. This application is made in compliance with County Ordinance No. 549. "JOB ADDRESS AND LOCATION___ _____.______ ___ Owner's Name ------------ �� 1 ,•-`---L - .-- Phone ------------------------- ---------- Address ---------------------- g IM9�l--------- +u T ------- Contractor's Name---------------------�f- - Phone_i�4._�_`_Q� ------------ - ------ Installation will serve: Residence [;Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms /___ Number of baths ,!__ Lot size ___Sa_r �� Water Supply: Public system lj�<Community system ❑ Private ❑ Depth to Water Table d�rft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe �ardpan ❑ Previous Application Made: Yes E] No New Construction: Yes Er"No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if�ju_bllic�sewer is available within 200 feet.) / Septic Tank: Distance from nearest well_i(w __ Distance ffPm foundation --- /s$'7 ------ Mafer�1_4---G--_�_ [r No. of compartments_.____ p2, ------------ Size__,.? .__' _,%ra__.___Liquid depth_____ j____ --Capacity_ � J Disposal Field: Distance from nearest well_ Distance from foundation_Q�_,i•_/ __-Distance to nearest lot line _________S_____ Number of lines _____________h_ Length of each line______�y Width of trench_._._ -� Type of filter material___1,_�4Depth of filter material_____- _Total length ---- $O______________________________ _ Seepage Pit: Distance to nearest well ------------------ _--- Distance from foundation -------------------- Distance to nearest lot line_.. ----------- ..- ❑ Number of pits.--------------------- Lining material -----------------------Size: Diameter ----------- ------- ----- Depth --------------------------------- Cesspool: Distance from nearest well -------------- ___Distance from foundation .................... Lining materiaf ------ .------------- .______ � ----------- ❑ Size: Diameter------------------------------ ------- Depth ------- -------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building -_---------- -_----__________ ❑ Distance to nearest lot line---------- ---------------------------------------------------------------------------------------- ---------------------------------------- Remodeling and/or repairing (describe): ....... -1V- ------- --` `IV -PE ______f------••-•--yC_4------------ ------------------ - ------------•••---•---------------------------------------------------------------------------------------------------- --------- ------------------------------- -------------------------------------------------------------•------------------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances. St laws, and rules and regulations of the San Joaquin Local Health District. $i ned".-0 ner and or Contractor( g j--- ---- --- - - ------,/ 1 By- - ------------ -----------•------ ,�{Title) ----- (Plot plan, showing size of lot, location of system in rerTt-- to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- 77T7 F?`;;�-------------------------------------------------------------------------- DATE ------------3-----/2.57 _4�0-- --- --------------- REVIEWEDBY ------------------------------------------------------------------ ----------------------------------------------------------- DATE----------------- -•-------- -- ---------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------•--------------------------------------- DATE------ ---------------------------------- Alterations and/or recommendations: ------------------- ---------------------------- i ------------- _-------------------------- _-------------------------------------------------------------------------------------------------------------------------------------------------------------------- ....._ _.___________________________._____._______:..____-______-_.___ ------- -------------------------------------------------------------------------------------------------------------------------------------------------- -- FINAL INSPECTION .-- -- -- --- Date - -'� jl T (�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 8-'59 F.P.Co.