8966 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit o. ` (--------------- (Complete --'_-_._.__.-LCom lete in Duplicate) Issued -7-11,14--7--- Date Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. � his application is made in compliance with County Ordinance No. 549. �L�-� IP—D- JOB ADDRESS A� LOCATION __�T___ -- -- crJ f-----------Owner', rjw e - t `'r`'u Phone------ ------------------------- -,1G3- " � -.S.,1C -------------------------------------------- ----------------------------- ------------------ Address... ,_ " Contractor's Name--r .� ------------- •-------------------- Phone.. "3vs 1..- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: __[.____ Number of bedrooms ___x___ Number of baths ---I--- Lot size ---i$,10J�_ _-_K-- rQ------------------------------- Water Supply: Public system El Community system El Private [Depth to Water Table ff-? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [0'-No ❑ FHA/VA: Yes ❑ No 52" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,Tank: Distance from nearest well-25;0-------Distance -- Dista`_e from found tion-14d-_e__p_._t_h_____M_ae"rial_s 4*A .________Capacity it y--------No. of compartments----- ------------------Size� Liquid Disposal Field: Distance from nearest well-.,4!-rc--- >_-Distance from feunciation___-�?7e---__.___.Distance to nearest lot kine___ ___________ Number of lines---------0------------------------Length of each line--------/'_Q---- r--------Width of trench of filter material___ __ ep h of filter material-----�_t.________._Total length__________ �¢_ ----------- Type Seepage Pit: Distance to nearest well___- l - ;;Mance from foundation__ —LX--..Distance to nearest lot lin �__ Number of pits----- �' `L-hfin material____ .�4_ ----__.Size: Diameter__-__,�$_____...___Depth_._._. -------- Cesspool: Distance from nearest well---------------__Distance from foundation--------------------Lining materiaL_.__-________.___._---.-_- ______ ❑ . a- 0..,q Size: Diameter--------------------------------------Depth------------------------------------------- ------Liquid Capacity--------•------------------•gals. .'rivy: Distance from nearest well-------------------------------------------------Distance from nearest bui#ding-----------------------------------------. Distance to nearest lot line---------------- ---.-'---•----- -----------.--�--�--.---------------------�-"-- ---------------------------------------------------------------------- " -------•--------------- Remodeling and/or repairing describe) ------ 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 the San Joaquin Local Health District. (Signed --------------------------------------------------------- ---------------------------------------------------- ------(Owner and/or Contractor) ------------------------------------------- By ------LjtiZ V1------------------------------------------------------------;---------------(Titl (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse s;�d . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- __ ______ ______ ________________ _ DAT !__.�j----------- --- REVIEWEDBY---------------------------------------------- -- ----------------------------- ----------------------------------- DATE--- ----------=� BUILDING PERMIT ISSUED--------- - = W - - r DATE- -- ---- -- - ----- Alterations and/or recommenda ions•_f_ __ _ ---------=---- - 4� _ � � --------------- ------------------- r (fI V------ E- er--*' FINAL INSPECTION BY:----- l" .1>1�>----------------- - ------------- Date----- / 7 ------------------------------------ SAN ----------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 5---9-2M Revised 1.57 F.P,CO.