11439 - Laserfiche WebLink

Home Browse Search

_ APPLICATION FOR.`SANITATION PERMIT Permit No. ------ 1. (Complete in Duplicate)SCANNEP Date Issued 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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------2142---5°----Laur-el---- �._�_:_S_tk n,.� a . --L----------------------------•---------------------------...- i i Owner's Name....MrR----and Mrse _Nathaniel'EJaek) Jackson - Phone__------- --------------------- Address .4-6x74 ► Address '2142---5-,------------------ ------------ ---------- ---------------------------- --------------- --------------------------------------------------..:------- Ho. 7727 Contractor's -Name---- Delta.--SFr_p_ 1C `I' -- ------------rV1C ---TriC'a----------------- - Phone--- i Installation will serve: Residence] Apartment House ❑ Commercial E] Trailer Court^❑ Motel ❑ Other E]e Numbei r of living -units:.!=____ Number of bedrooms __Z___ Number`of baths -_:-__ Lot size _-�fl .x_.16+ Water Supply: Public systemYO' Community system ❑ Private ❑ . Depth to Water Tabie4.5_--- ft. T Character of soil to a depth of 3 feet: , Sand ❑j. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] .Adobe E] Hardpan ❑ { Previous Application Made: Yes ❑= No ® New Construction: Yes E2� No ❑ FHA/VA- Yes ❑ No EX i s . 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted' if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-:'_______.-__ Distance from foundation---------------------Material----------------_-----------------------_--.--_-. ' Exinirig No. of compartments------------ -------------Size--------------------------------Liquid depth----------------- ---------Capacity..-.------------------- Disposal Field: Distance from nearest well...'-------------Distance from foundation----------------------Distance to nearest lot line---.__----__--._. EXiGing Number u e of of linesatereal_________.---------------------- -------------Length of each line---=--------------------------Width of french--,.-------------------------- type Depth of filter material-----------------------Total length--------:------------______._------------- Seepage Pit: �. 7 Disance to newest well-.--__no-_.__-__--Distance from foundation___-101--------Diski5nce to nearest 12t 1+ne ........... . E3 Number of pits _ _-_ _ Lining R,aaerial---_r-o—o.k.......Size: Diameter---�3_.------------ l: Cess ooJ Distance from Nearest well_ _ ___------.._Distance from foundation...-_-- ____` -------------- .----.Lining material ------------------------ P $ Size: Diameter_1-------------------#------------..De th---------------------=:------------------------------Liuid Capacity _--gals, Privy: Distance from nearest well------------------ _----_.-------__._______-___DiOance from nearest building-_------__----__----_-_--_-___-____-._---. ❑ Distance to nearest lot line .` "`- -------- ---------•--- ' �._ _ r - ibe):f :adding se8 epitto' existingsystem L _Remodeling and/or repairing (descr __._____ _ -- ------- ------------------------------------ ----- • 1 ---#------------------_-- ----------------------------- ------- :-------•-------------• -------------------- ----------------------------------------------------------•__-__----------------------- ---------------------------------:---------I-----------------I---------------------------------------------- I 1 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 avid regulations of the San Joaquin Local Health District. - (Signed)---------Ihs _ t _gyp_ G--- '- k---S rY C-$- --- )1C_._ .------'---------------=-------------------------------------(Owner and/or Contractor) F sy; P e_rr Karl han=' = {Title}__.Q en.- -Mr° (Plot plan, showingsize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , r . FOR DEPARTMENT USE ONLY APPLICATION ACCEPT] D BY_�._..fY DATE { W 1 -- - --------------- ------------•- •---- DATE-------------------------------•---------------------------- BUILDINC� PERMIT ISSUED .' . - ---.-------- ----------- -------- ---- -- ----------•---- ---- DATE ------------- - REVIEWED-BY+---------Y----- ------------- Alterationsand/or recommendations-------- -- - ------------=---------------- --------------------------------------------•-• ---------------------------------------------- - -----------------------•-------------------- s ► �� rrr�s �-r�r��_z- --------- r .. -�---- T -------� ---- -7./M � __..._. ISS f' c � ` _e----- ------------ Q � r �=-----�A -- ----- .�------- ---------.-r�= .-- • C� t.. -1�..nI...... 4----------- ---------------------- ------------------------------ --- � f /�J�J//(fJ w_ * r 'FFNAL INSPECTIONDate : _= = = l�TL ` = F=OR F'+`r— ON.L_y 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 't t ES-9-2M . Revised 1.57 F.P.CO.