16184 - Laserfiche WebLink

Home Browse Search

# FOROFFICE USE: -------------------------------------------------- --- -------------- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__�.[fl,l _. ---------------------- (Complete in Duplicate) ------�..--------��--------------= -------------------.- .This Permit Expires ] Year From Date Issued Date Issued ...�5".� 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 Coun Ordinance No. 549. I .;2_'6 �,3 l am, "o i S .F C , t JOB ADDRESS AND L CATION- [ -N.R - �`-' �: ths� Jowqa Owner's Name__..--•---.....B - OUR---------n 1-:K,1AN._ ------_ -- . Phone.-,................................. Address.............F_ -•• 77. .............. _SC-p L i. Contractor's Name__.i11=:..D, RlY�tl l p- ._..._ •--- -• ----•------ - -- ............... Phone................................ Installation will serve: Residence Apartment HouseCommercial Trailer Court ❑ Motel Other El' Number of living units: ----(._ Number ofbedrooms� E] El----. Number --_----baths . Lot size ...hrC-�.��:�----•--------------....... Water Supply: Public system E] Commuriity^ syst m ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 fee# .`Se`nd``- .,�rGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan- Q I Previous Application Made: (If yes date.........;---------) Nojr-"New Construction: Yes ir No ❑ FHA/VA: Yes ❑ No TYPE,OF-INSTALLATION,.AND,SPECIFICATIONS:--- . (No septic tank or cesspool' permitted if public sewersyeveileble w thin 200f. fee ++ w Septic T �s once from nearest well___+(?- - pilw'ence l� f P ,�g,� ffrom foundation Material..•--------•---------------•.. ::.. r' • ��i✓/N ,-compartments-------------- -Slie` •. 11— A' Ca pacify-.-.-' Disposal Field: Distance from nearest well c - ,. F p Distance from foundation....` ___.._..._Distance to nearest lot line.... Number of lines_-,, ines____ _________ ---- /-___-•-Length of each line��___,��'�1Nidth of trench.-----..3E7/( • Type of filter material...KQ--•--"-----pepth,of filter material-•---_I Total length....... =_.... f• � Seepage a e Pit: Distance to nearest well-.______--_I-__g4 JDisfanc�m foundation....................Distance to nearest lot line---------- +� p # •r . 0 ❑ Number of its---...-- -----Linin 1rrtaterial------------------------Size: Diameter-----------------------Depth------------------------------ �64 _ �• Cesspool: Distance from nearest well--------- __ _Distance from foundation,. _..__,___._,_.,Lining material_____..._____:_:..._.______.____. - --_ ❑ Size: Diameter__:------------------------------ ------- --•-- �= Depth--- -----••----- - --------------------------Liquid Capacity.. gals. Privy: Distance from nearest well_________________ :- --------- -__; Distanoe,•,from nearest building__._______---_______---- -------------- r.. ❑ Distance to nearest lot line ----------- `------ - -------- - ------ --......... ---- - _ .-r. - -- --- --------- •-• --- - -----•----•-- ------ ----- -- = -------- ---- -- ---- Remodeling and/or repairing (describe____________________________ ---------------------------------- ------------- -----••----•----------.-••-- - ------------------=- = ------ = _ -_ _ =_= I hereby certify that I have pre red this appficati n and that the work will be done in accordance with San Joaquin County ordinances. St ws,. rules a egul s f thSan Joaquin Local Health District. (Signed)- k. a _ - � � net and/or otrctor] By � _ -� _ a -------- -•-• --- ' - --------------------- - (Plot plan, showing size of lot, location of system in relati�n moo-wells;rbuildings etc ca be placed on reverse side). FOR DEPARTMENT USE.ONLY= APPLICATION ACCEPTED BY----- �i__R D---------------- -----------+--•------------------- - DATE------ _.. /_^. REVIEWEDBY__. ---------------------•_-------------------------•----------------•---•------------------•-•--. DATE BUILDING PERMIT ISSUED---------------------------------------------------•--•--•-------------------•------- ---- __ DANE--- - -------- -------------------------------•- Alteration . . - .----•--------------------••--••••-- ---------------------------------•-•---------------- - ------ --------- - ----- - le- A ....... E `----- -- -- ----------------------------------- FINAL fNSPEG, ON B + -------•- -'- ... -. ._ :: bate.. �� rt ............... . w s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 Wed 91h Street } Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 =M 5-61 ASIAB r