11646 - Laserfiche WebLink

Home Browse Search

!- APPLICATION FOR SANITATION PERMIT Permit No. •---- (Complete in Duplicate) Date issued � 16 � ® This Permit Expires 1 Year From Date Issued 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. 54 . JOB ADDRESS AND LOCATION `- --------------------------------------------------- ------------------------------------------------ a t Phone------------- ---- ------------ 4?1 - ------------------------ Owner's Name--------ee ` 0,044 Address-----------� +��' -- Phone----------------------------------- # Contractor's Name---- - - - -- --- - ••-----------•----•--------- - ------ ---------•-------------- Installation will serve: Residence partment House [3 Commercial E] Trailer Court [_1 Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms -_�__ Number of baths _---- Lot sizer �, � -�---•---------------•-------- Water Supply: Public system ®community system ❑ Private ❑ Depth to Water Table "ff. Character of soil to a depth of 3 feet: Sand F1Gravel F1Sandy Loam-E] Clay Loam [ICClay,[] Adobe ErRardpan ❑ Previous.Application Made:.-Yes [I No �yNew Construction-. Yes [&-No ❑ FHA/VA-: Yes ��No [_1TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A_ •- Mat:aria`--�-f y - -------- Septic 7 Distance from nearest well---_-��--Distance from found ation_______--- No. of compartments__-___ :___-_-=----Size__ _._ Li uid de th_- _---------CaPac�ty..-- ��-�/ r l . �' i 1 Disposal F'Eld: Distance from nearest well_.-'�._-;:=Distance-from foundation_.__IL9______--Distance to nearest lot line__ ____________ * = __ ength of each kine__ - Width of trench-__ -------------- Number ------ Number of lines__ -___�___ _______-'-- e - _/ �� n e to nearest lot line ._s �____-_____Total len th___-_—--------- Type of filter material-� -��-- epth of filter matericil�:, � q ---,�„ 5_r J_-____.. Seepag it: Distance to nearest well------"�.-_----Distance fr m�founclation- ��-_-______.D�,ta�G • Linin material__ _ �G .Size:'Diameter__ ------.---Number Tr;of pits.--___ ___--- g Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia4___----.-._.___---_._________,______ r ❑ Size: Diameter--------------------------------- --Depth---------- ------------------ Liquid Capacity----------------------------gals. Distance from nearest building------------------------------------------ Privy: Distance from nearest well-------------------------------------------------- ❑ Distance to nearest lot line------------- ----------- - t'- ------------------------------------- - --------------- --------------- ----------- h .. - -------------- _______________________________________._--_________ Remodeling and/or repairing (describe)_------------ ---------------------------------- ��J ' F ,¢ ------------------------------------ this done ' ancee65+ate ilawsh have application the San Joaquin the Localwork Heawill l heDistr ctn accordance with San Joaquin County ordinances, ` ' o Con+ractos) ------------------------------ (Signed) i a. - (Title}------�d,�-�� Plot Ian, showing size of lot, locatio system in relation_ ___________________________________ By-------------- - --- y ( P lation to wells, buildings, etc., canwbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___C�a_.<_z�--- ---.-�'.�--`-�€' --:�ls�'' --------- ------------------------- DATE---�--�--f-�-~.�--�----- ------------ -- DATE------------------ ---------------------•------------------- REVIEWED BY------- ------------------------------------- ------------------------------------ ----------------- DATE---------------------- ------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------- Alterations and/or rec mmenc�ations:-.--------- ---- �- --•-----�----------------•--------------•---------------•--------------------------•- i_ .._ ------- --------------------•--------- ------ --- t ------ -- ------- ----------------- -------------------------------------- FINAL INSPECTION BY:..- Date_.-. -"-1.7-��- ------------ ----------- ---------- ----- --. - � SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street in-,Sycemcre Street 814 North "C" Street 130 South American Street Manteea' CaliforrSie Tracy, California Stockton, California Lodi, California J „i + ES-92M Revised 8-'59 F.P.Ca.