SR0084392_SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ......................................................... APPLICATION FOR SANITATION PERMIT Permit No. _---__ --........._.._.._ ........... ..-----. (Complete in Duplicated t Date Issued Z514 1 y ......................... ...... I This Permit Expires 1 Year From 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 in compliance with County Ordinance No. 549. D -6 _ �AV `- JOB ADDRESS A D LOC ION. Owner's Name__ .�-Yi.. "��--�.-------..�.�--•j............ . . .:........ L'.,! ._.........--------------- -- .. Phone._._..---------•=-- •-- - ----- ----- •--•-----....... � 9 Address --- - .._.. 7 0 -.. ------ --•- - -................................................... v+ M Contractor's Name ........... - - --- ------ _.. -- ' ---- Phone ..� Installation will serve: Residence Apartment House Commercial D Trailer Court ❑ Motel ❑ Other ❑ 1 I Number of living units: ___. Number of bedrooms .-.. _.. NumZcDe f baths ___ ._. Lot size :.........__._._ ___ _.-...._._ Wafer Supply: Public: system El Community system Privatepth tWater Table,....... ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam C] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {lf yes, date.... . .... ...I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . J [ o septic tank or cesspool permitted if public sewer is available within 200 fee+.j ; I G ,,��^^ I Septic ank: Distance from nearest well. fe" _ -_ Distane from f and tion _..._��...._..Mattial_.... No. of compartments . Size _ .�' � Liquid depth ._ . .. __.._.... Capacity..) . ..:.., �. Di�pos Field: Distance from nearest well.. f2.::7t"Di ante from founds ion_. ,� 4�__�__Distance to neerest lot line ........... .. Number of lines...._...p... g ! i ( ._y__. . Len th of;each line. .9.�1._.�' _.Width of trench______ ________�.._..._____.. ; i4 Type of filter material.-__!x�I:.ff�__ Depth of filter.�material...... f?"r-__.-Total. length --------- e i "�..._. 1 Seepage Pit: Distance to nearest well -- _..Distance: from foundation... ...... .......... Distance to nearest lot line ................. ! r 1❑ Number of pits ........ Lining material-__ ..`.::._... size: Diameter.-.... .............. .L Depth ..................... __......... N Cesspool: Distance f:om nearest well ----------------- Distance from`foundation1,._._._........... Lining material ........................... ......... "0 Size: Diameter- ---------------. ................. Depth__......_..: ...... ------------------ /--....Liquid.Capacity ------------------- Privy: •------- Priv : Distance fromnearest well.................................................Distance from nea`rest-buiiding......................... .._._... Distance to nearest lot line ....................... - . ...... -•----------------------------- -------- -------- •-i--- .......... ------- I ----- r J c ^ ' . . Remodeling and/or rapa'ring (describe): --- - --- -- _ c ._... - -' - - i ...................... ------- --------- - -� _ ___ _ _ ._____ ___-- .. ...... - ...... ------------ I ---------------- } I hereby 7cerfihat I Have prepared this application and that the work will- be dofie'in accordance with -San Joaquin County' il ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ,a t (Si9ned)-- - Owner and/or Contractor ••------------------------- -............ -_----•---------•------------------------------------- ... _....(Title .................. -........---..._.... --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)./ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... -------•--..... .............................. •---•-...........__.. DAVE.: __": ^...`.��._......._-- -- REVIEWEDBY....... ------- ------------------------- - -- ----------------------------__.............._......_ - ----- .... DATE.------------------•------ - ----- ---------------------- ...... PERMIT ISSUED --------- ....... ......._..-•-•--.........---........_..._..._._.......••• ..........- - ....... DATE r-•--- --•--------------•----_ Alterations and/or recommendations: ................................... ............................... ._.._----------- .----------••--_._.------------------------- .......... r (..._------------------------------------ .------- -.......... .--------------------------------------------------------------------------------------------------- --------------------- -------------------------------------- f .......... .----------.------•----•-------------r-.---•----...................:.....•-•------...............I__------.........-•---•---•--....-----.....---•-----.......-.....-..........-•------..............._......---•-------..__.................. ........... ---------•------------------------------------------- -•-------•--- •----------•--•- ` ., . .. r = FINAL INSPECTION BY:.-�"�'"� ' -- '.................................. — _ . �.._ Date_ ............... -----•----- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California E6 9 REMSED B-59 3M 3-'63 F.P.CD. V