7719 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 27�.7 Li...... (Complete in Duplicate) Date issued Applica+ion 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. JOB ADDRESS AND LOCATION....14-i__►` � � 1 r C��'�_.�!��_._Nf��S r';�e�✓� J��----C,(�c's-� c9� �� -- ----- ---- ----------- Owner's Name_ U!�J�Y._-----Q--C---• / _j7_......� 4 .e_C ------------ - - - ---------- - ------------------------ Phone--------------- -•----- ..... Address-�--•C---------�I .. v � . .. 1 E �'�f, ---------------------------------------- Contractor's Name "!�1f•�'� ` Phone-----_--•--.._.. -•--------••-•-•--•-----•-••--------------------------------------------------------------------------------- -•----•------•--_ Installation will serve: Residence [-] Apartment House E] Commercial F] Trailer Court ❑ Motel F] to,�k Number of living units: .------- Number of bedrooms -------- Number of baths ________ Lot size _17-C ' r� f-______________ ___ Water Supply: Public system ❑ Community system ❑ Private E--_D_epth to Water Table ?.S ft. Character of soil.to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ p ❑ W Previous Application Made: Yes ❑ No � New .Construction: Yes.ENo ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_c -0Q__J.__Distance from found9tion_Z! �j?!/.Material-___--�_ __ -----. -------------- M1 .._. No. of compartments-.-------'-�--------__-.Size,�:e',�� Q_� Liquid depth----4-0-r.---------------Capacity._1_5.•1 --- Disposal __ Dis ni Field: ------------ Number oiolines�arest w ¢ __ ength of each line atio f`-�f;-----Widthcoftfre chnearest-��' Je p .-Distance from Type or filter materiaL__j :l _... 5fir__Depth of filter material______ZR---------Total length---------- .................... Seepage it: Distance to nearest well....,�_a ------Distance frorM foundation__,_k1A____ stance to nearest lot line Number of pits------ __Lining maferial0_�:'�___��O� Size: Diameter____ �='_._ _ _fi- --Deptn_ -_____ r- ; Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material_____.___________._.______________. ❑ Size: Diameter-----------------------------= Depth------ ------------------------ --------Liquid Capacity_--------------------------gals. C� Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___________-_______________.._______._. i ❑ Distance to nearest lot 1ine-------------------------- -- ---------------- ----------------------------------------------------------------------------------------------- Re Y eellling and/gr rep g (describe)• ✓ --------- -9-----------1 �`� ---•--�-�•a ` ---•---........---• -----------------------Z_& -4------------------•-•----------------------------------------------------------------------------------------------------------- ---------------------------------- --------------------------------•---------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------- --------------------- ......----------------------------------------------------------------------------------------------------•----------------._.....-----------------...------------------------------------------------ I hereby 4e tify that have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a+ laws, and rules and regulations of the San Joaquin Local Health District. r ---------------------------�� r O r and or-Contractor �... e (Signed). - BV ��- ......I : --------------------------(Title)--- -' ----------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -------- --------------------------------------------------------------•--------------- DATE- --------------•- --------------------------------- REVIEWED BY------------ ' - -- , DATE BUILDING PERMIT ISSUED-------------Z -------- ---------------------------•-------------------------------------._ DATE-------_----------------- _19-C----------------------------------------------- BUILDING Alterations and/or recommendations:-_--- ------------------------------------------------------------------- -----------------------------_•--_-------•----- -------------------------- -------------------- ---• --- ------------------------------ •----------------------._..,.---- .................................•------------ -••------------ r ---------- ------ -------------------------------------•-------------------------------------------- -------------------------------------•----------•--------- ---•-•----•----------------•- -------- -----•-------------------------------------------------------------•---•-------------- --------- -----------------------------••------------------------------------------- ----------------------------- ------------------------------------ ---------------------- -------------------------•-•---------------------------------------------------•------..-..------•----------------------------- r FINAL INSPECTION BY:. Date = -�--- ------------ 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 f ES-9--2M 145446 ATWOOO 12-54