68-360 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- Permit No. -- •-—•`� 4 I APPLICATION FOR SANITATION PERMIT (Complefe-in Duplicate) Date Issued .. -= •- ='f%� -------- ------------- ----- - � This Permit Ex fires 1 Year From Date Issued - - P --------- ---- --- ) A lication 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 LOCATION5 .�--Y--.. _ -- ---- . - - --- ------------- --- Phone---------•---------------- ------- - ' -- --------------- Owner's Name------ j r� /,! E = '- = = _�----------------•---------•--------•-----------------•----•--- Address-------,�. ;34.2 one - - -- Ph Contractor's Name.... _.. ------•f------�------•(-------°-.. - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ "Number of baths-./-.-. Lot size ---,�.� Number of living units: .- �._ Number of bedrooms . 7 Water Supply: Public system ❑ Community system ❑ Private [1-"Depth to Water Table ------ ft Adobe Hardpan ❑_ 1 Character of soil to a depth of 3 felef- Sand ❑ Gravel ❑ Sandy Loam Cla Loam Clay ❑FHA/VA: Yes ❑ No ❑ € No ❑ Previous Application Made: {If yes;date------ ---- -- I No ❑ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) nearest well .. Dfrom fondation....-. ..p.f ..-...Materia Septic Tank: Distance from ----------- . - - Liquid deP}h---� ---- ----Capaci y__ - No. of compartments_.._.-ysize i Dispos Field: Distance from nearest well...__'S_vt--Distance from faundafion---...i'.Q_-�.--.Distance to nearesfi lot�ine------ ------- Number o f lines. r- ----Length of each line.. ------` 4-------------- Width of trench. Type of filter material....-- Sj_o--------Depth of filter material-.------ 7-,- ----.Total length-.l-4l1....----•----------•-----• Seepa a Pit: Distance to nearest ;e . .._../_PA Distance from foundation---...�..�._�- Distance to nearest lot Iine...S....-_.-.- {^ 7� Number t pits___ _ Lining material -9.tZ-° Size: Diameter... ,3- Depth- 2-s-- - ----------------- Number - ----• U` T Distance from nearest well _-.-------.Distance from foundation............ .... ..Lining material..._...----------------------------- Cesspool: Capacity - El Diameterl-- -------- ----- -----------------Depth------------------------------- -------- -..-__-..Li qu�d --------- --- ------ ---- gals, - It _. Distance from nearest building------------------------------------------ Privy: Distance from_frearest well---.--------........_..-_-... ❑ Distance to nearest lot line ----------------------------------------------------------- . . ..4 ----------------- --------•--------------------- -.. \ Remodeling and/or repairing (des ribe)-------- - --------- ------------------------------------------------ --------------------------------- -----------------=--- ------------------------------- ------------------------------------------------------------------------- --•--- - _ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ti ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. +� -- ----------- -- = ------------ ¢P�t�d/or Contractor) (Signed1 Y:------------- ------------ (Plot plan, showing size of lot, location of system in relat n to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-f-------- ------- DATE--"Y.-�*75-714-?----------- --------------- ----- l -------------------------------------------- ------ DATE-------- --------------•---•------------------------------- REVIEWEDBY---------------- -- ------------ ----- --- --- - -------- BUILDING PERMIT ISSUED--------1 ---------------- ----- ------------- DATE--- - - Alterations and/or recommen ations:....................__._.._...---.-.----------------------------------- - - ------- --- ------------ ---------- - ------ -- - - ---------------------------------------------------- -------- -------- - . ..... -------- ........... i FINAL INSPECTION BY: - _ -- - - --------------- - ----------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Fla:ellon Ave. 300 West oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press