3322 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

Uy' APPLICATION FOR SANITATION PERMIT Permit No. -___33 -v - (Complete in Duplicate)fl� e Date Issued ----------------------- Application _---- :'_---__'S^_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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- -------- A'-�CN�--- = --•------------ Owner's Name _8-G+N..Q --------------------------"-------- ------ ---------- ----- ----------- Address.........------`-/-s --- /----•---�u IVtyrylS_r'O� •----------------' =------------------'--------:__--------___------------------ ......••-------...................... r t Contractor's ------- ------------- •--------=--=----•--- Phone-_5am-•-3�-_-.------- €Installation will serve: ' Residence ® Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms A__. Number of baths 7- _____ .-�____ Lot size ---��?__X___ __ ------------------______ ____ Water Supply: Public system ® Community system [_1Private [-] Depth to Water Table 347ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay'Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No [41 New Construction: Yes ®' No 01- TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material______________..____._._________-___..__________- ❑ No. of compartments----------------------`__Size-----------------------------Liquid depth---------- --------------Capacity------ --- ------------ Disposal-Field: Distance from nearest well__...._----------Distance from foundation----------.-------%Distance to nearest lot line----------------- 0 Number of lines-----------------------------------Length of each line------~------------ -------Width of trench----------------------------------- Type of filter material_____________________ _Depth of--filter material------------------------Total length__-_____________-.._--____.__-..-_._-.__-- r Seepage Pit: Distance to nearest well_LIUC-414;----Distance from foundation_-__ -_----------.Distance to nearest lot line__.....__..- a 1 ® Number of pits---------- ____-----_Lining material_ C&?AASize: Diameter------1-3----------Depth------;Z ---------------- T' Cesspool:' Distance from nearest well_________`.____-Distance from foundation--------------------Lining material____:______.________________.___-_. ---� ❑ Size. Diameter.------------------- ------------- Depth-----.---t=------ :----------- ----Liquid Capacity-----------------------------gals, Privy: Distance from nearest well _________________----------___-___..______,_._Distance from nearest building--------__.______. Distance to nearest lot line-_ " =------" =' ---------------------------- Remodeling and/or repairing (describe):_____._ F --------------------------------------- -_':_:' __ ------------------ -------------.---------------------------------------------------------------- _.___-____-____--------------------------------------•------------------------•---------------- -------------------------------------•-----•-----------•---------------••------------------------------------------------------------------ i ---------------- ------ ----------7-•---------------:---------,-------------•------------- ----------- ---------------•------------ • ------- --- 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. C �r �"_ =, Q-�[I . lY-C, -------- (Signed)-.---- {�' Cont actor) R. ZP.-�?y.X_ ------------------------------------ ---------- -------------{Title)-- /` ------- ------------------------ (Plot plan, showing size of lot, location of sysibm in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------- Y --------------- ---•----------•---------------------------- DATE- ------- -r----------------- REVIEWED BY------------------------------------------- ------ DATE-r/------- //�� —moi---••-•2........--•---- BUILDINGPERMIT ISSUED------------- ----------------------------------------------------------- DATE--------------------------------------------- ---•-------- Alterations and/or recommendation s:-------------------------------------------------------- ----- --------------------------•---------•-----------------------------------------•-•----------- -•--•--------------------•---------•--------------------------------•---------------------------------------------- --------------------•-----------•--•------•------------------------------------------------------------- ----------------- -------------------- ------- - -- ------•----------------•----------------------�Y_".'------------------Date FINAL INSPECTION BY---------------- �� V 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 r ES-9-2M 10-52 Revised W-2100