12016 - Laserfiche WebLink

Home Browse Search

r"'11% 1--,' APPLICATION FOR SANITATION PERMIT Permit No. .1 z.erl . (Complete in Duplicate)Z This Permit Expires 1 Year From Date Issued 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 com fiance with County Ordinance No. 549. if jgd7 �.. fF161�Er 144Y Z6 1 !! JOB ADDRESS AND LOCATION.------ -- Box 680--A, first driveway West of Beecher Lane on Owner's Name---Ernie--&--Lena--- ------------------------------------ South side of Linden Road, no, 2 2910 - --- ------ Phone--------- -- ----------------- Address - - - Address ---------------Rt, 13k --- Box---68o-A�-__Stockton. Calif, ---------------------------------••-------------- -------------------------- Contractor's Name--- D(3 t&-- eD1; C '&Llk Service,,....AA. Phone A9" a".12.b9 Installation will serve: Residence OC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ -__ Number of bedrooms _-_ _-- Number of baths --- 1-- Lot size --- 177__-X- _8 ---------------------------------- Water Supply: Public system ❑ Community system ❑ Private E] Depth to Water Table __45 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [I Adobe IN Hardpan [] Previous Application Made: Yes ❑ No ® New Construction: Yes :j No ❑ FHA/VA: Yes ❑ Nod] 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----------------- Distance from foundation ------------------- .Material -______.-_____._-__--____-_-----.._-----------. Existing No. of compartments--------------------------Size----------------------------Liquid dept --------- --------------- Capacity— -------------------• _ Disposal Field: Distance from nearest well___ G"'__ Distance from foundation--_ `-- Distance to nearest lot line --------------- Ex i ------..----..Exp S A�i ex Number of lines--------�.---------------------Length of each line-----------k'�-_-_.------.Width of french ---------------..----.------------- GG��% Type of filter material---__ -/�q-( 9 �_ Depth of filter material_--_-�$------------ Total length------�'t---------------------------- Seppage Pit: Distance to nearest --------Distance from foundation-- A.0.. ---_-_.Distance to nearest lot line- t----------_ U Number of pits ------------ 1 ---_.--Lining material ------ 9Ck------ Size: Diameter ----3 '.' ........... Depth_..?.5_': --- Max ----.---- Cesspool: Distance from nearest well ----------------- Distance from foundation - -- ---------------- Lining material ------------------- ----- ------------- ❑ Size: Diameter -------------------------------------- Depth ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well -------------------------------------- -------- -- Distance from nearest building ------- -------------------------------- --. ❑ Distance to nearest lotline------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or. repairing (d cri e):x____$dalri @-p-epage pjt O EXistiri system --------------------------14 ..... "'74" IC9;b ---------------- -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- --------------------------------------------------- 1 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. llelta Septic Tank Service, Inc..* Owner and/or Contractor (Signed) ------------------------------------------------------(/ ) -------------------------------------------- - -- By:--------p-B3'ry_..Q•.__ Warthan--------------------------------------------- igen. Mgr , (Title) ------ ------g - ---- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART ,M_ENT USE ONLY , APPLICATION ACCEPTED BY DATE ------------ -----------C----------- REVIEWEDBY----- --------------------------------------- --------------------------------------------------------------------------- DATE -------------------------- BUILDING PERMIT ISSUED---------------•------------------------------------------------------------------------------------- DATE ------------------------------ - Alterations and/or recommendations:-------------- --------------------------------------------------------------- ------ --------•---------------------------------------------------- ---------------- �i� --------------- ---- --- - - --- - - - --- -- - --- y j-,� __ - - , - - - - ---- -- ---- - FINAL INSPECTION BY:--- --------------- Date �� = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streef 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 6-'59 F.P.Ca.