10053 - Laserfiche WebLink

Home Browse Search

"�]"W•e APPLICATION FOR SANITATION PERMIT Permit No..w`S� �4 d 1A �itv�3iv�, (Complete in Duplicate) - - ,, Date Issued . 23 E . ,v .�• S r- ` 171 _' 0 --o 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 County Ordinance No. 549, 610f_21 JOB ADDRESS AND LOCATION ---------Y(/L �4C� $ QY� _ a _ Owner's Name - -- - C(/ ( WrUen O�LSZ� — A., ne-- %#-0----5-� Address-----------------------•---y-� ------ �_y _q W . Contractor's Name -------- --------------------------------------- Phone. ---------------- ----------- Installation will serve: Residence jX Apartment House ❑ Commercial ❑ Trailer�C'zour�frv---'/Motel [� Other ❑Number of living units: _)_____ Number of bedrooms �._ Number of baths __�_Lo�t si Water Supply: Public system ®Community system ❑ Private ❑ Depth to Waters-TaHe ________ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loanf da Lo m Clay Adobe p ❑ ❑ Y ❑ " y ,,�r ❑ Y ❑ �ardpan ❑ Previous Application Made: Yes [] No �' New Construction : Yes. FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if L3ubk sewer is available within 20 eet.)� Septic Tank: Distance from nearest well--____._ _____ Distance fro -f ondation__/_Q________.Material _____&_(&MOA__-___ No. of tom artments_ Z _Size___ K 3 ---------------- ----------. Liquid depth -----Y-------- ----- Capacity—_12-0 -- - Disposal Field: Distance from nearest welL___�v`_�" Distance orr foundation --- Disposal G� h r 4-Dis#ante to nearest sat line --- 5._ __.-_ - er ufin§_ ____________ Length of each line -------- �_------ Width of trench______ � f_t______.___________TYPeof fl material __i-& --------- Depth ojfter material____%Zr(.__`_--------Total length-------%e----------------------------- Seepage ----------------------- Seepage Pit: Distance t nearest well- Linin -Dat pan l.from foundation____________________Distance to nearest lot line ___________._____ P g - Size: Diameter------ --------------- Depth --------------------------------- Cesspool: Distance from nearest well ----------------- QiAance from foundation__._._.. ---____.Lining material ------------------- ❑ 5 ze: Diameter-- De #----------------------------- --- -----------------Liquid Capacity-.----------- gals. Privy: Distance from nearest well________________ Distance from nearest V3 <❑ Distance to nearest lot line_ - y1 Remodeling and/or repairing (describe)=----------------------------------------------------------------------------------------------------- R L L 4 -----------------------------------------------------------------=-------------------------------------------------------------------- --------------------------- ----------------------_._----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules an regulations of the San Joaquin Local Health District. [Signed) r ' ----------- �� .(Owner and/or Contractor) By:-----------------•------------------------•-------------------------------------------------------------------------- --------(Title)---------------------------------------------------------------- (Piot plan, showing size of lot, location of stem in .relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- DATE �_ 1S- -S --------------------------- REVIEWED BY ------------- = ------------------------------------------- -- - -------------------------------------. DATE--------------------------------------------------------- -------------- -- - -- - ------------------------ UILDING PERMIT ISSUED --------------------- ------------ ------------- - -------•--------- ---------------------------- DATE------------ ---------- -- ------------------------------ -- - Alterations and/or recommendations: =------------- -------------------------------------------------------------- ------------------------------------------------------- -----------•-------------------•-------------------------------------•---------------------------------------------------------------------------------------------------------- ---•--------------- -----------------------------------------------------•----------------------- -----------------------------------------------------------------------------------•-- ----------------------------------•--------------------------- ------------------------------ ------------------------------------------------------•------------------------ t------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- 6 6 FINAL INSPECTION BY: ---------------------------------------------------------- ----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, Celiforme `' Manteca, California Tracy, California ES -9-2M , Revised 1-57 F,P,CO. y