20772 - Laserfiche WebLink

Home Browse Search

C_r>7� --- t. - ---- - -- -----_-_- `fit', a(APPLICATION FOR SANITATION PERMIT Permit No. ---------- ------------ -------------------------------- i (Complete in Duplicate) " This Permit Expires 1 Year From Date Issued Date Issued __- -��' -------------- --- .a .: 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 compliance •th County Ordinance Kip. 549 JOB ADDRESS AND L CATION_ C1 - -- -- ..6 0 Owner's Name C �� ( _�- .S_ t _- :*, r -a-_) - -- ------------------- = Phone Address `' 3 3 �r trr. ' 5 -�. Q -- ------------------ ----- - . - - ILL Contractor's Name________ _a � � --•--_...__ Phone----•------••------ ••--••--------- - --------------------------------------------------------------------------------- Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...._ - Number of bedrooms _ Number of aths ._a. Lot size .-------�-c- Water Supply: Public system ElCommunity system ❑ Private Depth to Water Table _� ft. ` t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0' 'Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (I€yes,idate--------------------) No New Construction: Yes No } ❑ ❑ FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept -- stance from foundation_--,/Q---------.Material------ �) •-- � L-� }{ Se tic T Distance from nearest w -- _'_-___Di �p Li Liquid de th_____ .-�- J No. of com artments-__--_ Size_ ¢ q p ----------Capacity---- -CA ---- Disposal eld: Distance from nearest wellQ I __ _Distance from foundaf n��_ _ .Distance to nearest lot line__-_______ Number of lines-�__----____�rr._-__--_----_Length of each line___- 7.5 Width of trench.-__rD. Type of filter materia! ------------- Depth of filter material--l_ -f�---------Total E length_jV- __ --__--__- u See pag it. Distance to neares. .'well.'-- /--- ---/-Distance�rom-foundation,--,-.J - Distance to nearest lot line__ Number of pits____ Lining materiaL�_. ._L? -.yi. Size�'Dia"meter... , -_! ,,_-Depth__- _ -_--_ ----- Cesspool: Distance from nearest,.well---_--________-_Distance from foundation_____________-____--Lining material__.-..__________..--_-- - --- ------- ❑ Size: Qiameter- ---- _ ------- Depth-------------------------------- -j-- Liquid Capacity ---- --- -----gals. Privy: Distance from nearest well-- -=---------------`_________ -------.--Distance from nearest building --------------------- r ❑ Distance to nearest lot line'.__._..___-___._.__..____ Remodeling .and/or repairing (descri ---------- � P � ------------------------------------- ------------------- s ' .------------------ •- - ------------- ----- ------------- - ----------- e ----- _ . -- - I hereby certify that i have prepared'fhis application and that fhe work will be done in accordance with San Joaquin County ordinances, Stat1 ws,'and rules regulations of the San Joaquin Local Health District. (Signed)------ ------ 1 -- - 1 ..� ------------- (Owner and/or Contractor) BY� ------------- -�- { 1 ` �;hJ t -� - (Title)----� J �� - ----- ------------------ of plan, showing size of !o , I cation of system in relation to uildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY !� APPLICATION ACCEPTEDI -=Y'-- -= ---- - --- ----------- ----------- - DATE.---- FIEWBY --- ---- BUILDING PERMIT ISSUED_- -------------------- ----------- ------------------------------------------ DATE-------------------- - , -------------- Alterations Eand/or recomm-erndation ------ --�---am---------------------t--'-l--�--,---c--C-'----- r ----=----_---------r---`----r-._ DA1T�E---------------------- ------ # rl 's:------ -- �---)-c r �� = z - r --- -----y- �------ ----- -------------------------------- --------------------- ------------- -- ----------------------------------------- FINAL INSPECTION BY:...... Date--- ---� a SAN JOAQUIN-LOCAL HEALTH DISTRICT r 1601 E.ka:erten Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P. D. 9 i