9667 - Laserfiche WebLink

Home Browse Search

a APPLICATION FOR SANITATION PERMIT Permit No. ___ .x.6..----- (Complete in Duplicate) 1,0D 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 wit County Ordinance No. 549. ©e6,— 3 o 9 6- 41" 0 01 / F JOB ADDRESS AND LOCATION...------- OCATION... XW_W,1_A_V - o Owner's Name------4 ----- P.-1-!e----- `-------------------------------------- ----------------------------------- Phone------------------------------------------ Address-----------a `� - --- ----- --•-- ----I------------- j ---------&------------------- Contractor's Name---- J Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __4 Number of bedrooms __ Number of baths Lot size _______________________ Water Supply: Public system ❑ Community system ❑ Private ®"D5epth to Water Table OV"ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes gq,'No ❑ FHA/VA: Yes [L�--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if __.___+ic sewer is available within 200 feet.) Septic Tank: Distance from nearest w Distancp f om foundation-_/0-__-_--Mate ai__�°� No. of compartments.__. __---- Size_- -- --- - --.--Liquid depth---- ---_._.--Capacity__. - --- Disposal F• id: Distance from nearest e - Distance from foundation_____ _�--- ___-_ ff�_________Distance to nearest lot Number of lines___ nth of each line_ g q�-�-._ __.Width of french_.___ Type of filter material___ _/ epth of filter material___� �____._Total length___ v' --- ----------------- i or Seepage Pit: Distance to nearest well___1 ------Distance frpm oun tion--_ _,• N .L � ___.___Di tan�e to nearest lot line___ _ _______ [�� Number of pits-----�----------Lining material- p ----- ue: Diameter.- - " -De Depth--- -----•----------� Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material--------------------------------------- ❑ Sze: Diameter :---- ------- Liquid Capacity - gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------.-___________----___-____-.---. ❑ Distance to nearest lot lire-------- -------- ------ ------- ---------------------------------------------- Remodeling and/or repairing (describe):-------- C -- ---- --- --- ------------------------------- •----------------------- -- --------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rakes and regulafons of the an Joaquin Local Health District. � Contractor m (Signed)--------- ----� - --- ---- ` /eI�J j ----(Title) ------ ------ � By: = -----------Y. � (Plot plan, showing size of , location of system in relation to wells, buildings, etc., can be placed on reve a side]. 1 FOR DEPARTMENT USE ONLY /1 - r APPLICATION ACCEPTED BY------------ ---------- ---------------- DATE-----`� `._ -�-- ---------------- REVIEWEDBY-------------------------------- ------------------------------------------------------ DATE--------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- r ....D.ATE------------------------------------------------------------ A ter datio s:--------_---- -------- ----------------------------------------------- -------------•--------------------------------------- �i. y [°R' {------------------- --------------- -•--•--- ----------------------------------------- -------------------- --------_'__----ll!!!_/.._------_-._---- --r--- -------------.------------------------._------___----__---____-_--_------_-__._________.___-------.----_-__----- J ----------------._---____-__-----__.__--___-__.___._------.---- --___,__-____-----.------------------------------------.--_.---_-.-------__-_-__-_..-.-.--_-----..//_f__[_G_y__._____'."/_"_��_'_'__¢_�_._r.'.___._.____._._._____`------------------- FINAL INSPECTION BY- -------------------------------------------------------- Date ------ --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 F 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California r ES-9-2M Revised 1.57 F.P.CO. .*'