12784 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION ;KNIT Permit Na. _ _1 2•--7 (Complete in Duplicate) �/} This Permit Expires 1 Year From Date Issued Date Issued ______l____ .__�e-/ 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 Ordinance No. 549, Y, J,, D, 6,5"94. 6596-Z 4 JOB ADDRESS AND LOCATIO .�! / 1-----/ <S tl..— Owner's Name--- ----- -------------- Phone....._�__4c� � Address-----�-a----jL__R�-...__ Contractor's Name ---n------ r --------------- -------------- Phone..------P.__4 S-?03 ., /`� Installation will serve: Residence ❑'"Apartment House ❑ Commercial � Trailer Court E] Motel [:] Other E]- . N._I � , . „� - L.ArxoF�. eAMY x Number of living units: -------- Number of bedrooms r_______..Number of baths -------- Lot size __ t__________________________________________ Water Supply: Public system Community 3 tem Private De th to Water Table 444 .'1I PP Y= Y ❑ r Y Y ❑ _ . :. p SRT br i2T Character of soil to a depth of 3 feet: -Sand ❑ Gravel ❑ Sandy Loam,❑ Clay Loam ❑ LC I!Y ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No$0 New Construction:Yes-141 No ❑ FHA/VA: Yes ❑ No tZ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f`-- i �~ t � + Septic Tank: Distance from nearest well---SO- -_-_Distance from foundation_L_07______.__.Material-___&?_0;D_GIr�_d_Ll-------------- 2-� No. of compartments_____..___ ,___....__Size._:�j_ _ _iC_S_'___,___Liquid depth_---._��---------------Capacity....46_0 --- Disposal Field: Distance from nearest well....�Q_.._Distance from foundation____`____?___.Distance to nearest lot hne.-S_---------- 10 0 Number of lines......3------ Length of each line_�x�_.7.2_x.Z4-_Width of trench_._„n//.--______.__________ Type of filter'materiaL__. -___._Depth of filter material-----)-fir------------Tod hlength_'jL7�--------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation...........----____.Distance to nearest lot line..--__________.._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------.----- Deptk--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_____________1--.-.Lining material.....-..._____._-_._---__-___________ ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------L__Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Dist an ce4 from nearest building-------------------------------------- ❑ Distance to nearest lot line-------------------------------------------------------- -`---------- ----------------------------------------------------------------------- Remodeling and/or repairing (describe= = '” t -•-----------'---------------------------------------------- --•--•------•-•-----•-•--------•------•------------------------------------------------- i - !I' � + I r 11 r 1 I hereby certify that I have prepared this application and,that the work will ,be done in accordance with San Joaquin County ordinances, S�aate laws, and rula anddrregulations of the San Joaquin Local Health District._ , d� C'GG (Signed)- = F (Owner and/or Contractor] -- ---------------------------------------------------------------------------------(Title)---------------------- --------- (Piot plan, Sh_ Ing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----... - -------------------------------------- DATE REVIEWED BY------------------- ------------------------ I—.... DATE-------------------`------ - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------- DATE------------------------- -- ------------------------------ Alterations and/or recommendations------------------------------------------- ---- 4 } ---------- --------- -- - ----- ------ -- ------------------------- - ' ------------------ ----------------------------------------- --------------- ------------------------ FINAL INSPECTION BY:----------Y__-7---- Date-- --- ?i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street k Stockton, California Lodi, California Manteca, California Tracy, California ' ES-92M Revised 5-'59 F.P-CO. I