12459 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �D - G� .�N 1 (Complete in Duplicated Date Issued -__�� ! o v o ce,3 om P D 11�7f r?a This Permit Expires l.Year From Date Issued / I A lication is hereby made to the San Joaquin Local O gena}ncD'NoG54or a pe/mit to construct and install the work herein described. Thisapplicationis made in compliancewith ith County ncg? t "'; ;^,-._._ -------•----------------- �r r.---- - JOB ADDRESS AND LOCATION_ = --- ,L > �� --- --- ----------------- --- --- ---- Phone-----•---------•----••--•-----•--•-� Owner's Name______ - . - _ Address ---------------•--------------------------------------------------------------------:------ one..--------------------------------- _ ------------------------------------------- Contractor's �jP Other Name___-.___-- -= -••--- - - - Motel ❑ ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ r Installation will serve: Residence Ap r ,� ----- ___-_-_-._ -_ Number of living units: _ Number of bedrooms . __ Number of baths -_____-_ of size ___ r t. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Clay716 Adobe ardpan ❑ Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam EDDYes ❑ No New Construction: Yes VNo ❑ FHA" Previous Application Made: Yes ❑ �No � f TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool p!rmitted if public sewer i available within 200�feet.) _ Material__--e°-- ate ------ -- r '-Ca acit -��-------- Septic T nk: Distance from nearest we}} _-- ____-Distance,jf f`Q da+��quid dep{h__�,p P Y No. of compartments____ ____- __Size_ __ _____ T i, � � � 11 __-Distance to neares# log line__>��__��---- -/Y--- pisposal field: ` ' Distance from nearest well.-.. Distance from foundation_. Width of trench_ _12-- ---------------------- F �Ir1_ _:__�._ ��jj ----------- Number of lines____-_�__ ------------------ Length of each line:_-.__ -;.,� __Total length ----i Type of filter material- -L�p��--Depth of filter materiaL`__f ------ g y i -----Distance from foundation _*�0...--•.Distance to nearest lot line_. ------- i� Dep ,th a2s --------------------- Seepage Pit: - Distance to nearest�.well_:__�r'.--- - ,p Size: Diameter-..��-.------ - --� ©/ Number of pits_---/-------------Lining material---�4-P� Distance from crest well_____-'----- Depth Ce from foundation - ;-__ LiquiLi ni d C pacity-------- ------------------gals. t Cesspool: _ ,• ❑ Size: Diameter.--------------- g--------------------- ------- Privy: Distance from �earest well-____n----------------------------------------- Distance from nearest building *------------- ------------------- ----- --------- ,. � ❑ Distance to nearest lot line.--------------------- f --------------------------•------------------ ------------------- /-�---- ------------ Remodeling and/or repairing (descnbe)---------- --- - - ----------------------•------------------ ------------------------------- ' ---------------------------------------------------------- C -'.-• --------------------------------•--------------- i hereby certify that I have r'e ared this application and,that the work will be done in accordance with San Joaquin County P. p ordinances, State laws, and rules'and regulations of the San Joaquin•Local Health District. ` s --�"---� - ---- ----- ------� ------ -------�---------- ------------ -I - - r Contract ' ---- -----r-1- o ------ 0 Si ned Title----- 1L1 - ' ------------------------------------------------ ---------- --------- laced on reverse side). (Plot plan, slowing size of lot, location of system in relation to. gY�------•------ --------------•------•-----•• buildings, etc.,_can. e p wells, FOR DEPARTMENT USE ONLY � N ACCEPTED BY_.__`"�-(_R-�-�----------------------------------------------- ---- ------------------ ----------------------------- -------- DATE----- jf�--�� _---�-�--------------------------- APPLICATIONDATE-------- ---------------•---------•------------------------ i ---------------------------------- ---- --------------------------------------------- REVIEWEDBY------------------------------------ -------- DATE.-------- - --- ---------------- BUILDING PERMIT ISSUED------•--:�------------------------- ----•--- ---------------- --- --•---- Gy---------= or recommendations:__..-_-/-- Alterations and/ �-'�� --`-•-�- ----�-----------------------------------•--•- --------_--- ------------- ------------------------------- �- -------- Date---- l FINAL INSPECTION BY;... _----------`---- ! SAN JOAQUIN LOCAL HEALTH DISTRICT 844 North "C" Street •i32.syoamore-Street 300 Wet Oak Street Tracy, California 130 south American Street Lodi, California Manteca, California Stockton, California ES-9-2M Revised 8-'59 F.P.Co.