12896 - Laserfiche WebLink

Home Browse Search

]-UKUFFI�-,E USE: -------------------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. ............ ------------------------------------------ --------------- (Complete in Duplicate) ---------------------------------------- I------------- This Permit Expires I Date Issued _Nz��A f, Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in complian'ce with County Ordinance No. 549. JOB ADDRESS AND LOCATION.__---- _j_/ P 0�_Vol/ !�; , / lZe J---- -----Or_1Jffz ---------------------------------------------------------:-------------------------------- Owner's Name---------- 4!� j r 4�, . ------- ---C--------�� -I a"�./_-k� It 1--v---------- ------_-----!:•----_-------_---------------------_---- Phon,e---...---------------_----- Address--_-----------_-- -0--------- i-c-Ay I. ff-VA/--------I----------------- Contractor's Name-' 7 ------------_-------e�_io......�a. -------_-L---------------------------------------------- Phone_-----------_----------- Insfallation will serve: Residence [P,"-Apartment House [] Commercial E] Trailer Court 0 Motel 0 Other Number of living units: __--f__ Number of bedrooms ---Z-- Number of baths Lot size ---- Water Supply: Public system Er-com munify system C] Private F] Depth to Wafer Table:57 Character'of soil to a depth of 3 feet: - Sand El Gravel E] Sandy Loam E] Clay Loam L] Clay ❑ Adobe 3--�Hardpan El Previous Application Made: (If yes,'date------_-_--------) No �ew Construction: Yes M <o El FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tack or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: -Distance from nearest well_4—-----------Distance from founclaflon__/a-_---_-Material C-0- EA,-' No. of comport encs---------7 1 ----------- I ----------.Size--------&G-XV-0...Liquid depfh - ------4 _Capacity..- --------------- Disposal Field: Distance from nearest Well-'-rDistance from foundation---1.0 / Distarice to nearest lot Nu�mber of lines------_----------I /..__-_ ---------Width of trench. ---------------Length of each line-_-_--_-e9'0 Type of filter Depth of-filter material_-- ------------Total 1- _ — — -U, —_ — . -- . len4th............�.g......I----------- See e-Pit: Distance to nearest'well___-' _ --------Disfani�e from foundation- D`istalriGe to nearest lot line-- --- ------- ----- Number of pits------L--------------Lining- material----1A_./1,0_f__V.-Size: Diameter._,? ---- Depth 4 ------------- Cesspool: Distance from nearest wet!---------------- Distance fr6fn foundation___------__._.----.Lining 'm2aferial_ 1771 Size: Diameter--------------------------------------De pth_--_ ----------------------------------------Liquid Capacity--------_----------------gals. Well-------7 Privy: Distance e from nearest ---- __-_Distance from-nearest buil8ing------------------------------------------ ❑ D;stan-ce to nearest lot 1-ine---------------------------------------------•------------------•---•- - - Remodeling and/or repairing (describe)-------- ----------- 71- -------------------------------- --------------------------------------- --------------------I------------ --- -----------------...... __ , -------------------_--- -------17 -----------------------------------------------------------------------------------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. 11?41 h- 1 ----------- -------3e_e_�� --------- ---------- -- ----- (Signed)---------- ........=Z�- --—---------------------- and/or Contractor) -. !--------_----------- A- (Plot plan, showing size of By:.---_--_-------- - ............... ......... .�o=afl c;;erysf system in relation''to wells, bujld�ings, etc., can be placed'on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- Y------ -------------- --------- ----- ------ REVIEWED BY --- ------ ----- DATE.,--------z_�' ----------------- ------------------------------------- ----------- --------- #1�--- -- DATE-_.------ ----------------- --- --------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------- _-- --_------_----------- DATE.----------- ---------------------------------------- Alterations and/or recommendations:----------------77._: - ------------------------------------------------------------_------- -------------------------------------------------------------------- --------- -------------- ACJA_*-----I __ ---------0- -- .... ------- --------------------------------- .................... -------------------------------- ------------- ------------- -_--_------ -------------------------------------------- ------ -----------------------_-------------------------------------------------------------------- ------------------- ---------- ---_---- ---------------------------------------11-1--------------------------------- -------- ---------------------------- FINAL -1-----------------------FINAL INSPECTION BY C7 / --------- Date--------.0! 2-2- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California' Tracy,California -P-CD.2.6-SM CS-9 R"ISED 9-59 F