11601 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

0 }APPLICATION FOR SANITATION PERMIT Permit No. ___/._� - 1 (Complete in Duplicate) � - bate Issued 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. JOB ADDRESS AND LOCATION..._____- 1138 Fairfax Street ------ ---•------------------------------------------ -------------------------------- Owner's Name------Hence LEr@ Prand Phone Ha 4--5x-838 ------------------------------------------------------------------ Same i~5 above Address_..... -------•-- - Contractor's Name________ "A• Parrish & Sons Inc. Ho 6-9607 - --------------------------------------------------------------------------------------------------------------------------- Phone------------=--------------------- Installation will serve: Residence E� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: __-�_ Number of bedrooms _2----- Number of baths Lot size ____50-t- X120 Water Supply: Public system NJ Community system ❑ Private ❑ Depth to Water Table ---451 f 5 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe ®XHardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli_________________Distance from foundation--------------------Material----------------------------._________._________- EXpsting No. of compartments--------------------------Size---...... ----------- ------Liquid depth----------------- ---- ---Capacity------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_________________ Ex ting Number of lines-------------.---------------------Length of each line------------------------------Width of french-----------•------------------_---� Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ t Seepage Pit: Distance to nearest well_-_.______�On� _____ D€stance from foundation___x _____._..Distnce to nearest lot `ine _1.______._ C] Number of pits----- -------I------Lining material_--Rock------ Size: Diameter___._33____--_---Depth--_2-5------------------------ Cesspool: Distance from nearest wel€-----------------Distance from foundation---------------------Lining material-------_____--_____._-__.____________ �. I ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ____________________________________-----------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- 1 Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------. -------------------------------------------------------------------•'-------------------------------------------------------------------------------------------=------------------------------------------------------------- -----------------------------------------------------------------------------•--------------------------- ------------------------------•-------------------------------•------------------------------------------------ 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, and rules and regulations of the San Joaquin Local Health District. D.A.Parrish & Sane Inc _._______Owner and/or Contractor (Signed) ---------------------------------------------------------- { ) By:-------------------------------------B lI Wri-g-ht--------------------------------------------------------------(Title)-----Est•-------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- ---------------------------------k--------------- DATE---------fjv REVIEWEDBY---------------------------------------=--------- -------------•---------------------------------------- DATE------------/ --------- BUILDING PERMIT ISSUED------------------------------ ------ DATE-------------------------------------------------------------- Alterations and/or recommendations______________________________________________________ ---------------------------- 1`r-: �. r -r+1- ---------� -o-=------------------------------------------------------------- ---------------------- ----------------------------------------------- --- - ---------------- - -------- - ---------- -- ------------ - ---------- ---------------------------------------------------------------------------------------------------------------------------------- ---- ----- -------------------------------- - -- ----- --------------- --- FINAL INS ON ------- - --_-- Date---------- __=. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American $freet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.