12697 - Laserfiche WebLink

Home Browse Search

I � 6q APPLICATION FOR SANITATION PERMIT Permit No. __ _.-.-•/.•..-...__! (Complete in Duplicate) �gt+q Date Issued This Permit Expires 1 Year From Date 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. [93Z-0 ^,' , JOB ADDRESS rAND LOCATION-- ,�v, / - ----------- ;----- 'j '"°"---••-•------------------ Owner's Name--/'-�-----• ,er'd,� :0 �-°------- ----------------------------------------------------J.r1�- _ Phone -------•--- Address-------------•--------'------------------------------------------------------ ----------------------------•------------------------------------- Contractor's Name _` f�f1t�•-4I _- one Apartment House ❑ Commercial [:] Trailer Court E] Motel ❑ Other ❑ Installation will serine: Residence Ip Number of living units: --4----- Number of bedrooms _3__. Number of baths ;^---- Lot size _h :�__47164*----------- ----------------- Water _____________ _Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 24-- ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam X] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No P) New Construction: Yes X1 No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No.septic tank or cesspool.permitted.if,public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_--c<a-------Dista.ncq from fou ndation_f_P____._____.Material�-- __________________________ No. of campartments_________ _____________Size__`Ar_�_? ---Liquid depth------ ------------------Capacity-/ --------- —10 Rw Disposal Field: Distance from nearest well_.d'`.—_a---------Distance from foundation..--/._p___._____-Distance to nearest lot line��___-- i ] Number of lines______ __________..___.____ _Length of each line....... "________________Width of trench_. V ._______..__.____.__� Type of filter material Depth of filter material-`e'..... ----- -Total length-A-YA------------------------ Seepage Pit: Distance to nearest we I_______ ------------Distance from foundation__________________Distance to nearest lot line__-___________._. El Number of pits--- 1--------- -------Lining material-----------------------Size: Diameter------------------.----Depth---------.----------------------. I Cesspool: Distance from nearest well_______________Distance from foundation-----._._-_______..Lining material-------------------------------------- ElSize: Diameter-------------------------------------Depth--------------------- ----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest of ine------------------------------ -------------- -----------------••--------------------------------------------------------•------- Remodelingand/or repairing (describe):-----------------------------------------------•-------------------------------•------------------------------------------------------------------ I -------------------------- --------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ ----------------- --------------------------------•=------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- rL1C�.- 11�/►�nK.�r' ^t '--- - -----------------------------------------------------------------------(Owner and/or Contractor) Bri------------------------------------ ---- -------------------------------------------------------------------- {Title) (Plot plan, showing size of lot, locatioe of iystem'in-relation to wells;"buildings;'etc., can be placed an reverse side). b FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------------------------------------------------------------- DATE----/.n�!y.x�/------------------------------------ REVIEWEDBY------------------------ ----------------------------------------------------------------------------------------------------- DATE----- ------------------------- -- BUILDINGPERMIT ISSUED------- ------------------------------------------------•--------••----••---------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendationst I----------------------------------------------------------------------------------------------------•-----------------------••----------- I f .I ------------- ------ ----------------------------------------------------•--------------------------------•-•------------------------------------•-•---- ---•---•------------------------------------------------------ FINAL INSPECTION BY:-/44,; ------------------------- ---- -------------- -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 WOst Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 2M R—v S.d 8-'59 F.P.Co. .�