13388 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------__A__1_1 - i------r.3 U_�2 -OA 'APPLICATION FOR SANITATION PERMIT'`M'. Permit No. -- --1 — ��%I -------------------------------------- (Complete in Duplicate) Date. Issued __g�-�.�-�-• i - This"'Permit Expires 1 Year From Date Issued Application is hereby made to the San Joagitin 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. JOB ADDRESS A C %'IN'_______ -" 7 - --------- --------- ------ --------- Phone--------------------------- --------Owner's Name- -== L-•--- = -_-----•-------------------- 75 ------------- Address --•------- -- -- ..� ,. ..:a;:. _ ----- -------- Contractor's Name_-------- ---G�d�.� � 'fi-F--.'._..._-•------•-----•-•--- - --•--------•-------•-----------•--------•------•-•- __. Phone Installation will serve: Residence 2--`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units: -_ Number of bedrooms :_r,Z Number of baths _ ___ Lot size -••----• Water Supply: Public system' Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam El Clay Loam E] Clay E] Adobe lardpan ❑ Previous Application Made: (if yes,date-.-__.._--- _) No �ew=Construe#ion: Yes. No �FHA/VA: Yes E3 No El TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.] i Tank: Distance from nearest well_________________Distance from foundation__--______-�_____.Material____---.___'__.--------------------------------- No! of compartments------- ---------Size-----•------- ------Liquid depth--------------------------Capacity-------------------- I p al Field: Distance from nearest welfl________________Distance from foundation--_____--___I___-_.Distance to nearest lot line_______-________. Number of lines --------------Length of each line-----------------------------Width of trench--------------:-------------------- Te`of filter material--------------------------- of filter, ��`-------Total length-----------------=---------------- -• Yp �_ ! ► 5eepag it: Distance to nearest elL!_ f -Distant m f ndation._1-------- !---Lining ��to nearest lot line__ - . ... r_ Number of-pits....." _ ^--3---Lining material_ --- �C ---Size: Diameter---"4---------.Depth------a- !- ------------•--- Cesspool: Distance from nearest well_________________Distance from foundation-__._____._-____..Lining material___.__.___-"__..____________._______- Q ❑ Size: D;iame+er_-------------------=------------------Depth- --------------------------------------------------Liquid Capacity---------- gals. I t!^r Distance from building Privy: Distance;from nearest well--- --------------------------------------------- sancerom nearest 4------------- --------••-------- -------- Distance c ❑ to nearest lot line-------- ----------------------------------------------------------- ----------------------------"----------------------------------- -- - -- Remodeling and/or repairing (describe)---------------------- -------------------------------------------------- ----------- ---•------- ----------- ____________________________________•---.__t____.________...____.._._____."._______.. "____._._____ _______________________________ I h y cer i that I have-prepared this application'and that the work will be done in accordance with San Joaquin County ordinanc S, St to I s, and rules and re 'ons of the San Joaquin Local.Health District.- f (Owner and/or Contractor) 5i ned. �� 1 _ - '8-�—. ----------------------------- ----- IT d (] [Plot plan, showing size of lot, location of system in relation to wells, buildi gs, etc., can 6e placed on reverse side). i # F� FOR DEPARTMENT USE ONLY .. --•- - -- - r ; t r ---------------------- DATE------Sf -f��----------------------------- APPLICATION ACCEPTED BY_____4 f REVIEWEDBY - '= = n-- ------ DATE---•----------------'---------------------------------------- : ", ' ---+-- e DATE y BUILDING PERMIT ISSUED--------,I$g----------I-------------- ---------: 1. l !1- - Alterations and/or recomme ati ns __ �x �__ �_ _, -- �__ _� t�f_-_--�4.:..--�-nj _ . _. ----------------------------- ----------------------------------- ------ ------`- --- --- _ •--------- -------------------- ------- --------------------- ----=---- -�----------` - =' FINAL INSPECTION BY:_._. `_. ._ Date---------- ---- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California L Lodi,California Manteca,California Tracy,California E9-9 REVIeEb 8-59 F.P.0 O.•jM 6.60 � y - f