12408 - Laserfiche WebLink

Home Browse Search

. o N Permit _-- APPLICATION FOR SANITATION PERMIT P / (Complete in'Duplicate) Date issueda o This Permit Expires 1 Year From Date Issued 05-S•__z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe (}T�h'is/ rapplication isI'n?ade ir} compliance with County Ordinance No. 549. _44 comp L - JOB ADDRESS AND LOCATION..__--_o__ � �-J _��--F�... -------- Owner's. - --- .Owner's.Name la�9f —r -- -_- ---'`-- -- -_- Phone !F Address ' - 41-1i - -- ----- -- _ Phone- � � D Contractor's Name----- ---- - ------------------- •- - --- ---= -= -- - - - ---- - - - --- -- ------ Installation will serve: Residence )e Apartment House ❑ Commercial ❑ Trailer our, ❑ Motel ❑ Other ❑ I Number of living units: /-----: Number o5 bedrooms --- Number of baths [XI Lot size .-__-----1_0.- ..+e..---------------_----__ , . Water Supply: Public system ❑ Community system ❑ ..,Private ( Depth tb Water Table.,-'7- ft. Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes F-1NoNew Construction:. Yes.0 No ❑ 'FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND.SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic -Tank: Distance..from..nearest,well_---.,.�O_-_--Disfan prom foundafiors,-'_1_q-------Material--.--Q._ ----- ---- ------------------ _t No. of compartments--------- ------------Size- / X- ----s'-_.Liquid depth -------4-----------Capacity--)2a r�--_-- s Disposal Field: Distance from nearest w0__LSQ-_-_-Distance from foundation---- ,, ------Distance to nearest lot line___ r-B.--. I ' Number of lines---------4Z- --- Length of each line------->�0 �---li-----.Width of t t of filter materiaL.�------Depth of filter material-------f_1-_-------Total length-----Ak_ Pit: Distance to nearest well--------------------_Distance from.foundation--------------------Distance to nearest lot line-__--_--_---... ❑ Number of pits.---------------------Lining material--_--------------------Size: Diameter-----------------------Depth---------.----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------.-.--__-------------.__-_----- ❑ Size: Diameter--------------------------------------Depth------------------------------r---------------------Liquid Capacity----------------------------gals. Privy: Distance from Inearest well-----_----------_----------------_----_----.--Distance from nearest building---------- _------------___-_--------I' 171 Distance to nearest lot line------------------------- ------------------------------------------------------------------------------------------------------------------ ' - -•-------------------- ---------------------------------------------------•------------------- Remodeiing and/or repairing (describe)---------------------��'.�c�_-.- ----- --------------------•---------------•----------------------------------•--------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- -------------- - -------------------------------------- - --------------------•---------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and*sgulations ofthe an Joaquin Lace{ H lth District.Si ned - ------------------------------- /or Contractor) 9 --•--- ---By:------- - -------------------------------------------------------{Title)------------------------------------------ - -------- --------- (Plot plan, showing size of lot, location ls�ys;. inrelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY- a .------------------------------------------------------- DATE____ -R C1- r� -------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--------------- ------------------------------------•--- iBUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:----------------------- ---------------------------------------------------------------------------------------------------------------------- ------------- oe Y - - Date_-1�� " FINAL INSPECTION BY . - -_ - --.-.- ` SAN JOAQUIN LOCAL HEALTH DISTRICT v 130 South American Street ` 300 Wes+ Oat Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Man+eca, California Tracy, California tt ES-9-2M Revised 8-'59 F.P.Co.