12026 - Laserfiche WebLink

Home Browse Search

r APPLICATION FOR SANITATION PERMIT Permit No. ... -Q..z..� M1� (Complete in Duplicate) Date Issued 'J�rI"-------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinancee No. 549. _ JOB ADDRESS AND LOCATION-------- --�--�----- C Owner's Name -..SQ-li'LC-.-J----•------------------------------------------ ._. Phone Address----- ---••--- -------- g...------- -- .11 -LY/ .�- -- ----------------------------------------- ---------------/f Contractor's Name------------c.L �X.- ----- 7 � �.� cSLJr, Phone. Installation will serve: Residence K Apar men+ House!.[] Commercial ElTrailer Court E] Motel El Other ❑ Number of living units: _-- --_ Number of bedroomsl�__1�lumber of baths --I---- Lot size -------P_0---r[1 ------0---------------- Water Supply: Public system =Community system 0 Private ❑ Depth to Water Table��ft. r Character of soil to a depth of feet: Sand ❑ Gravely❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob 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 within 200 feet.) . ik tic dam— l Distance from nearest I Di -I well------___----- Distance from foundation___----------------Material------------------------.----_---__-------_- No. of compartments--------------- -------- !Distance -----------------•-------Liquid depth--------------------------Capacity---------------------.-.- Dspo�el Distance from ,nearest well------------------ from foundation--------------------Distance to nearest lot line----_---__--._-_- � Number of lines--------------- --------- ------- Length of each line Width of trenchP Type of filter-material -----------------------!.Depth of filter material-------------------.--Total length--_-----------_--_--_----___-_-_--__-�-- See a iff Distance to nearest well__ Q Distance om fo dation--_��_.--___.DistanF,p to nearest lot line- -__- p /� Number of pits--------I------------Lining laterial--- D-C .Size: Diameter--,3 ---`_ -----Depth--- ---------------- UA i Cesspool: Distance from nearest well-----------------Distance from foundation__..--__--------..Lining material_----__--___-------.---------_----- ! ❑ Size: Diameter-----------------------------------4IDepth---------------------------------------------------Liquid Capacity------------------------_-gals. " --Distance from nearest building Privy: Distance from,nearest well --- -------- ----- -----------:-- - - --------- ---------.------------------------------------------ Distance ------------------------- Remodeling - ----- ❑ Distance to nearest lot line--------------- ----------- ---------------- - -------------------------------------- and/o airin esc i �. r ------- ------------------------------------------------------- ---- / P 7 ---------- - :- ._:::--------------:::_� _____ _`____________::::______________:: ::::____ __-- _ �,oEn _________________--------------- f -- -- ---------------------------------- ------------------------------------------------ ------------- I hereby certify that I have prepared +his applithat t e work will be done in accordance with San Joaquin County ordinances, State laws, an rules nd regul - s f the�?San Joaquin Local Health District. (Signed)- ------ _---- Owner and/or Contractor) b -- ----- -- --------------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildi , etc., can be placed on reverse side). FOR I]EPARTMENT USE ONLY I,. APPLICATION ACC: PTSD BY ' == DATE------ ----------------------- REVIEWEDBY---------------------------------------- --------------------- --------- ------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------- ------------------------- ---------------------------- DATE--------------------------------------------------------- - ----------------------- Alteration an /Or recommendation ---•------------------•-------------•--••-------------------•------------•-------•------------------- - --- -----------------•-------------- ---- -- -------------- ---------------- - ----------------------------------------- - - FINAL INSPECTION BY 1 Date------- . SAN JOAQIUIN LOCAL HEALTH DISTRICT I 130 South American Street j 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5_9-2M Revised 8-'59 F.P.Co. -