9227 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ........J?4c 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, 0 44 7- 5'-o .7-1-1 JOB ADDRESS AND Owner's Name----teelolv---e------A4-0- f-/----------------- -------------------- -------------------------------------------- Phone.--- ----- �jj - --------------------------------- ......... Address_-.. 1-U.- Contractor's Name_ ------------------------------------ Phone-_,r6W,---4:-5.1 V- P Installation will serve: Residence Apartment House E] Commercial 0 Trailer Court F-1 Motel El Other F-1 Number of living units: --- Number of bedrooms Number of baths __7___ Lot size _1_0_12---------W__�_ _3---------------------- Water Supply: Public system ❑ Community system F-1 Private LK Depth to Water Table -f-- ft. Character of soil to a depth of 3 feet: Sand X Gravel El Sandy Loam E] Clay Loam E] Clay C] Adobe I-] Hardpan C] Previous Application Made: Yes [-] No PQ New Construction: Yes X No E] FHA/VA: Yes [j No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspdol permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___ZJ'_----Distance from fou-ndaf ion----ZZ-1---LMaterial------ - ------------ xf "49 No. of compartments--------Z--------------Size-------- ---------------Liquid depth----- -----Capacity..----- --------------- Disposal Field: Distance from nearest well---f -__-.-.Distance from'foundation__ Distance to nearest lot line.--/P...... Number of lines_______3 1 ge /P ----- -------------Length of each line'--- ---------Wid+h of trench-------7------------------------ Type of filter rn� f I ZWle----Depth Of filter maferial-----------------------Total length---------- -0---------------------- L_ Seepage Pit: Distance to nearest welf----------------------Distance frc,—mfTUnda'+io"n--------------------Distance to nearest lot line----------- El Number of pits----------------------Lining material--------_-----------_--Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well_______ _________Distance from foundation--------------------Lining material-_________________.____.____-_ Size: Diameter-------------------------:------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest Well.-r---------------------------------------------Distance from nearest building----------------------------------------- F1Distance to nearest lot line----------------------------------------------- -------------------------I---------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- ------------------- ------------------------------- `.Z 17.......... ------------------------------------------------- ------------------------------------- ----------------------------------------- ----------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ---- ---------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, State la and rules and r laii s of the San Joaquin Local Health District. (Signed}-------- /_J�------- - ----- -------------------------------(Owner and/or Contractor) By:---------1;: ----------------- --------------------------------------------------------(Title)----- ---- --- ---- ------- (Plot plan, showing size of lot, location o yst6m in relation to wells, buildings, etc., can be placed on reverse side). location A�oy, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- -------------------- ---------------------------------------- DATE---------/ REVIEWED BY--------------------------------- ------ - --------------- DATE--------------------------------------7 -- ----P-E---------------------------------------- --- - ----- ---- -- , BUILDING PERMIT ISSUED------------- ------------y---------—----------------------------------------------------------- DATE Alterationsand/or recommendations:-_--------------------------------------------------------------------------------------------I-------------------------------------------------------- --------------------------------- ------------------------------------------------------------------------------ ---- -------- ----------------------------------------------------------------------------------------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------1------------------------------------------- --------------- ------------------------------------------- ------------------/------------------------------------------------------------------------------------------------------------------------------I------------------------- z -- FINAL INSPECTION BY:---------- Z_g----------------------- Date----- f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 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.