9322 - Laserfiche WebLink

Home Browse Search

�s z . APPLICATION FOR SANITATION PERMIT Permit No. ____9__-____--____. (Complete in Duplicate) � I Date Issued .---• _-- -1...��-� 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 with C u ---------- nfy Ordinance•No. 54.9. 3 4 S JOB ADDRESS AND LOCAT ON--- ----- Q--------- Owner s Name-------- ---- •- - ' . .__ Phone. Address.......... 1- ------------------------------------------------------------------- } ------------ _- Contractor s Name--------------------- '�-'ta Phone -------- s Installation will serve: Residence {p''-Apartment House ❑ Commercial ❑ Trailer Court ❑ ,Motel ❑ Other ❑ _ a Number-of Number of living units: __/___ E`Jumber of bedrooms _. baths __Ox Lot size __ --- //aK4,0______-----------_______________ � Water Supply: Public system ❑`Community..system'❑ Private Y!T'1-'Depth to Wafer Table tt: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe*._5ardpan ❑ Previous Application Made: Yes ❑ No 9�' New Construction: Yes ❑ No gq FHA/VA: Yes U�lo ❑ 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__: (__ -r Distance from/oundation_____S___ ____-_.Material�__ _�._ No. of compartments ® Size Liquid depth Ak f Disposal Field: Distance from nearest well_. ----------------- __,_____Distance from foundation___ ----------------Distance to nearest lot line__ _ _ ...... Number of lines_._.`__ _________________________-Len Length of each line_____ __ j� - �b --'` 9 s� ------- Width of trench---- -----------------•-- Type of'filter material-_/�./JGl�_ Depth of filter material------- _ '*----Total �______________ _ _ Distance{to neares�el.l_-7�� ____Distance from found ation _--0--_____- a`ce to nearest lot line�_!.._...__... N Seepage Pit: ,,, � ®� umber of pits_:_____.___------------Lining material__/4__dd4._ Size: Diameter__>Y.___.______.___.Depfh____ ______________.._ Cesspool: D-rstance-from'nearest well--------------___Distance from foundation_._._______________.Lining material------------------------------------- Size: Diameter------ --------------------------De Depth --------------------------- ----Li Liquid Capacity.. ❑ .. p q -----•-------.- ----gals. Privy: Distance from nearest well----------------------------------------_--------Distance from nearest building__--------------------------------------_. �► ❑ Distance to nearest lot line____.�._:--- _ ----------------- ----- = /""' C " Remodeling and repairing (describe)=. ' ......... --------R-----•- i - -----------•-------- _____________________________________________________________________________________________________________________________________________________________________________`____�______-___-_-__________k ________..__-.-___.._ t ____________________________________________ __________________-------------------------- _----------------------------------------------------- _--------------------- -__________-________________-___________________._._-__ I hereby certify that 1-have prepared this application and thaf the work will be done in accordance-with-San Joaquin County . ordinances, State laws, and rul s and regulations o the an Joaquin LocalHeat District. -- --- (Signed)_---- -------------- ------------------------� � _ " .(�w�nen�ndfer Contractor) • Title y,,, ' BY----------------------------------------•---- �_ Iof_s_rfern -- - -- - -------------------------•--------------------(. }----------' �'��., -- ---------------------- (Plot plan, showing size of lot, locat- in relation to wells, buildings, etc., can'be placed on:reverse ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------------------------------------ --------------------—---------------------- DATE_— : REVIEWEDBY-------------------------------- -------------------------------------------------------------------------------- DATE------ BUILDING PERMIT ISSUED---------- ---------------------------------------------------------------------------------------- DATE-------- ------------------ - Al e atiom and/ore*, me cIataons:1= s " /I /- —"N +� ------ -, 1 .. _ - C;--- ---------------------------------------------- fl --------------------------------------------------------------------------- --------------------------------------------------------------- ----------------------------------------------------------------------------- i.. / "may/ 1 1NAL INSPECTION BY:. = '----`--== --------- .Date --- ---------- i of . 5AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street r 132 Sycamore Street k 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ;LS-9-2M , Pavisea 1.57 F.P.CO. _