10972 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. . __!___-7. ! (Complete in Duplicate) Date Issued 11 G/ Application is hereby made to the-San Joaquin Local Health'District for d-perrriit-'to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance-No. 549. d JOB ADDRESS A LOCATQN___ ,I ___±�- -------z--�` t ✓✓ =------- _c --------- -----------t �. Owner's Name-----[ ,�_----- -- - --------- --------------------- --- -------- ----- ------------------ -- --- - -----:Phone_:9-b--- --------------- � Address-----------------------��1"4-�-------- Contractor's Name------------ t.r? ,r------------------------------------------------------ --------------- ---------------- Phone r Installation will serve: Residence ® Apartment House E] Commercial 0 +Trailer Court E] Motel ElOther Number of living units: _!----- Number of bedrooms Sk-- Number of baths ----4--- Lot size _ ___>. __ '° --SO__-X___15C) Water Supply: Public system ❑ s Community system Private ❑ Depth to Water Table ___- --- ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or`cesspool permitted if public sewer is available ririthin 200 feet.)1 i SepticTank: No}of com artmentst well__ d _ __ Distance from undOtion_ S.? :_ .Material____ t7R_1rT. ------------- Disance from P ---Liquid depth-- ------- --------Capacity------86-!).... I_ Disposal Field: Distance from .nearest well____ ®__._Distance from foundatiori,__// I -- - (��____(_..Distance to nearest lot ----------------------Length of each line__ _a___`3_ Q------.Width of,trench-------Z _!1__------_-_--- Number of lines-_________� 6 << r; '.ype of filter material_`�'s.._Rik.��_-Depth of filter materiaL____t6________,___Total length--------�Q =S_--------------------- Seepage __________ _________Seepage Pit: r 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______________________________ _ _ ___ I ❑ Size: Diameter:--- f=-------------Depth----------------------------------------------------Liquid Capacity-------;--------------------gals. Privy: Distance from :ne.arest well-------------'_-----------------------------------Distance'from nearest-building---------_----------_-------------------. Distance to nearast lot line------------ " ---------=--------------------w---------- ------- Remo cling and/or repairing (describe):--- `Ijj_ '.j • --�fi`_i<_� d4 � i.,-`� I�h�?'h�'�.° _�./� f3 �I .. t --- .y'i�i� c' - ---8---------- --•- -- = -51_...?• - y °_ --------------- - " = -------------------- -- ---------=--------------------------------- ----- f ---- ------- ---- --- -------- -------------------------- ------- I hereby certify that I have prepared this application and that the work will'be Bene in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health 6kfrict. (Signed). --- -------------------------------------------- `�-== ------------------------------ ----=------------(Owner and/or Contractor) !� (Plot plan, showing size of !o , location of system in relation to wells, buildings, efc., (Title}______________ __ _ ___________ __-_ By:--• ------------------------- ------------(Title)----' be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY----T-Kc?-------- --------------------r= _-----=-= DATE`---- 1!� - --- ------------------- REVIEWEDBY------------------------------------------- ----------------------------------------------------------- ------ DATE------------- BUILDING ----------- BUILDING PERMIT ISSUED----------------------------------------- = DATE -=----- Alterations and/or recommendations--------------- -- -------------------=-----------------------------r-`-----------•-----------•------------ ... - - - ---- - -----------------------------------------------45.E .- �_ar------------ - ,t a� � ?--� --- -- C1 - ----- - gA ------- - ---- --- - ----- - -- UIA- - FINAL INSPECTION Y _ 71? 4- ------------ --- Date-------IQ-------- C7 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 ES-9-2M . Revised 1-57 F-P.CO.