19885 - Laserfiche WebLink

Home Browse Search

/ � FOR OFFICE - --- "_______________ ___________..___.__., 2__ r' APPLICATION- FOR' SANITATION PERMIT Permit No. .�. �$- ---------------- --- ----- -------------------- ---- Date Issued ------------------------------------------------ ------ (Complete in Duplicate] r - - - - �1- This Permit Expires 1 Year From Date Issued Application is hereby made t'l 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 OCATLO,N ;d Y =; _Owner's-Name °�--�- - - �- Phone4 6 • . - ------------------------------------------- f __ _7 Address �S`------N-- ��.51...A__' - -.A-�_r_1iV--------A-�/,---------------------------------------------------- ---- Q r Contractor's Name------•----------- ._ ..� -C'�-----.------ S-b-- Phone_ -C�a19 - .- 7------ Installation will serve: Residence ❑ Apartment House ❑ Commercidl ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of,living units:� _l__-, Number of bedrooms ._Number of baths ---I... Lot size __670__X-_I_S_r----_----------------------- Water --___ -- -Water Supply: P4 blicisystem�( Community system ❑ Priv�te E] Depth to Water Table- ft. Character of 'soil to a depth of 3 feet: Sand ❑ Grave ❑l Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0( Hardpan ❑ Previous Application Made: (Ihyes date-- Ir__, .__ -} No New Construction: Yes E:1No X FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: � (No septic'ttanVor cesspaol permitted if public sewer is available --ithin 200 feet.) ❑�` r - --------- oundation--------------------Material Septic T,c"Zrf co l`i artmE}s---nk: I Distance feiam nearest well----•--_- -----=D s-ante frim fo Liquid depth--------------------------Capacity-••-------------------- Disposal Field: � Distance from nearest well_________________Distan e from foundation--------------------Distance to nearest lot line________________ t g \ �'lA1G i r ❑�,e�.5 Nu�ber of; lines-•-------------- ------- - -- Lent th.of each I�ne__.___•----------------____--.Width of trent}�--------------.--------------__ --- �. TYf;. T i.al---=- Depth of filter material------------ ---------Total length------------------------------------------ Seepage Pit: Distance to � t _ _- - _._. 1 ; �a r Distance to nearest lot line__/�1___r-_.._ welLC(�Q�-�---Distant from foundation__ __ ___________. Number-of:�pitsQ' .____Lining material`-Q� ..----Size: Diameter3_ ...__..___Depth____ _`�_______________ i I x ,' Cesspool: Distance from nearest well_____________.__Dis;ance from foundation___________________Lining material---_..._-___ _ --_________ _________.- ❑ Size: D�am9 ter-------------- •..-•s►n#i , Qe th Liquid Capacity gals- Privy: Distance from.neares!Ww4-----------------------------------A------.-LRDistance from nearest building -----. ❑ Distance to nearest lot line---------- ------1 ------- - Remodeling and/or repairi ,'desc vibe _:__ ___ t --------- - --------------------- _ _ _ - _ t------ --- ---- ---------- i ------------------- ---------- --- -------------------------------------------------------------- - - -. - - ---- -- - -------------------------- - - -I ------- --- --------- - ---I---------------- _ ------------------------------------------------------------- _ I hereby certify t at I have prepared this applicationand that the work will be done in accordance with San Joaquin County ordinances, State laws, :and a regulations o ; he. San Jo_a uih Local Health District. (Signed) - : �M4 f / (Owner and/or Contractor) Y=------------- ----------------- it c ` (Title)--- -.- --- ---....---------------- _ t 8 (Plot plan, showing size of lot, location o system to relation to wells builjings, etc., can be plac on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B` .-- ." -------------------------------------------------------- DATE---------- � � �� REVIEWEDBY-----I---------------------II--- ------------ --------------------------------- ------- - ----- ---------- DATE------ --- ------- --- BUILDING PERM]t ISSUED-----!Il! . ------ --- I - --------------- DATE-------------------- ---------------------------------- Alterations and/or'recommendations. ------ ---- --------------------------- ----------- - --------- - -------•--------- ----------------- ------ ----------------- --------------------------•------------------•----------•--------------------- 1 - --------------------------- -------------------------- ........................ -------------------•--- 1N-------- - ------------------------------------------ ----------------------- FINAL INSPECTION BY:. ... =� �---(/----------- -------------------------- Date.- ------��-- -/--7---��' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lfaielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California w F.P.CO.