12766 - Laserfiche WebLink

Home Browse Search

01S 2_�_ . . C� � j�� APPLICATION FOR SANITATION cRMIT Permit No. 1p 4.- (Complete in Duplicate) ( Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local,Health District for a permit to construe ind install the ofk herein described. This application is made in compliance with County,Ordinance No. 549. JOB ADDRESS AND LOCATION------ -------------------------------- = ---------..-•--------------- � Owner's Name------ -------•----•-------------------------------------- r� . t ; e- -- ------------------------ Phone -------- ` I Phone--------•---------------•--------- Contractors Name----- 1 f Installation will serve: Residence ❑. Apartment House ❑ Commercial X Trailer Court ❑ Motel ❑ Other ❑ i 1 Y4 I �,a g r M (Z Number of living units. -_ - Number of bedrooms -------- Numberto# baths -------- Lot size � 3-.-"".""""_"------------------- Water Supply: Public system ElCommunity system ,❑ Private [g Depth to Water Table A' ft. Character of soil to a depth of3 feet: Sand Gravel'❑ Sandy Loam`jA Clay Loam ❑ Clay E] Adobe E] Hardpan E] Previous Application Made: Yes ❑ � N6 Nel Construction: Yes X No ❑ FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIF{CATIONS:'Ar tl i (No septic tank or cesspool perm 0ed if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest weii_9-10.. ...Distance pfrom�foundation---j_0--________.Material_.__R 17 "Ql ------------ 91 No. of compartments____ _ -1 b Size___ Liquid depth._._--. ._ Capacity � d---ldA-c,. " Disposal Field: Distance from nearest weii-Sb_"-t.._Distance from foundation.,�D_____________Qistance to nearest lot line.__1�t_....... 1 d +� Number of;lines--------'--------------A - =�Length of each line----��-��---�_"-----Width ofgtre�h._ -� '��, ,� Type of filter matenal___. p�-1 -.---Depth of filter material_____`_.! Total len th___ j •t� . sr 1 !' Seepage Pit: Distance to nearest well - _.�Distance from foundation____________________Distance to nearest lot lms_____.____"._____ , E t------Likn material---------- ------------Size: Diameter----------------- -----Depth--------------------------------- EJ g V ` Cesspool: Distance from nearest(w-ell-----_ - ;- :"Distance from foundation--..______.___.--- Lining material____________________________________. � Number o '; its___.'_____ __ Cesspool: Size: Diameter---------``-----------------`---------.Depth_------------------- --------------------- Li4uid Capacity �� µgals_ q4 Privy: Distance from nearest well------ 9---------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest,I f line-- - f ------------------------------------------------------------------------------ ----- ------ f Remodeling and/or repairing ','(describe): -`y --------.. --------------------------------------------------------------- -------------------••------"-•-------------------•I--------- -11;-------------------------------- ;.,s --- i -------`---------------------------------------•-------•----------•------------------------------ i I jij -------------------------------------------------- ------ ------------------------------------------- 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 !pnd regulation ;of th a oaquin Local Health District. I ; (Signed) = ` ----------------------------------------------- ---------------(Owner and/or Contractor) I --------------------------------- --- Tale L (Plot plan, showing size of lot,llocaticn of system to relation to wells, buildings, etc., can be placed on reverse side). k F j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -. - ------------------. DATE___.�-----1---------46-1----------------------- -- I REVIEWED BY DATE------------•-----------"----------------------•------------ BUILDING PERMIT ISSUED__.'___'___e_.1 I -------------------_D_ATE Al+erations and/or recommendations:._.'--------------------- --"-------------"----------•-----••------------------------------------------------------------------- f ---------------------------------------"----•--•----------------------------"--------------------------------------- i ---------------------------------------------------------- -------=-------•--------- ------------------------------ ----- ---------------- ------- -- FINAL INSPECTION BY:. --- ------ -(1_—__- L� =- � --- Date----------- �C ---------------------------------- 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 ES9-2M Revised 8-'59 F.P.Cc.