9767 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. �2- - (Complete in Duplicate) Date Issued --- Application -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-------_99-10_s f `� _. '�. Owner's Name--------- ---------------- Address------------ -----------•--Address------------------------------ t..� 1. �,>t f�� Contractor's Name-------------•-- AtL1-----, rtarl�.�---S4s.!-G--t2 ---S�.-rs------------------------------ Phone.__/649_` :_A4/,' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l___ Number of bedrooms.,-_ Number of baths ._Z Lot size ------ R.�,S_________________ Water Supply: Public system ❑ Community system ❑ Private [ epth to Water Table _57 __ ft. Character of soil to a depth of 3 feet: Sando'oGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑j No [jj—New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No 5;�'' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------_----------Distance from foundation--------------------Material___--________..______..___--.______.._-___-:__. No. of compartments--------------------------Size--------------- ------- Liquid depth----------------- -____Capacity Disposal Field: Distance from nearest weillS70----._Distance from foundation____�p_�......Distance to nearest lot line_,�------------ --------------------- 0_---___ [ � Number of lines'______ ________-/.--�f.-__._Length of each line-____. d_�___ _.._.Width of trench.___ ' ---------___ Type of filter material-----1.0o_-_t'�epth of filter material-------- -�- __.Total length-----.�0------------------------------ Seepage Pit: Distance to nearest well-------------_--------Distance from foundation--------------------Distance to nearest lot line_____-_-_._-.___. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth----------_---------------------- Cesspool: Distance from n p Size: Diameter._ Barest weff------------------Distance from foundation_---__-------_---..Lining material_____..-_-__---_-_________--,_.,__._ ❑ ------------ --------------------Depth----------------------------------- - --Liquid Capacity----- -- ------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____._____.- _-________..__-___-.-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------- = Remodeling and/or repairing (describe):-----------------r ,a�?_!-Tgs _�c,c___._ _----------_------•............ ------------------•--------------------------------------•---------------------------------------•-•--------------------------------•--•------------------------------------ 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 rule and re ulati s of the San Joaquin Local Health District. (Signed)) AlaT - --- ----- diontractor}----------- $Y� -- - {Title} - -------------- (Plot plan, showing size of lot, location ofsyst in relation to wells, buildings, etc„ can be placed on reverse de). FOR DEPARTMENT USE ONLY 1 ' APPLICATION ACCEPTED BY --------------------------------------------------------------s----------•--------------- DATE'��------- REVIEWEDBY------------------- --------- ' ---------------------------------------------------- ----------------------------- DATE_S�iol-------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------- --1--------------- DATE------ Alterations and/or recommendations --------=-----------------------------------------------------------------------------------•--------------------------------••-•-•------------•------------- ------------------------------------------------------------- ----------------- ------------------------------------------------------------- ----------------------------__.------------------ ---------- ----------•----------------------- ------ -------------- ----- ------------------X FINAL INSPECTION BY: �. Date------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street aro North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 3-57 F.P.CO.