17505 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r� _ --- ----------------- -,� - APPLICATION FOR SANITATION PERMIT Permit No. .,� ------------ ---------- ----- (Complete in Duplicate) Fv// Date Issued ___. _---------- This Permit Expires i 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. JOB ADDRESS AND LOCATION--------1-0.0-` a w---------------------------------------•-------•------------------------------------------- Owner's Name--------„lA�c,.c _. ctr..�/ ---------- ------- -------------------•- --- - - --- �----- -------------------------- ---- -- Phone-�a-�--�-�-+�--39?-4_•--- Address-----•-----------•- -►rte_ Contractor's Name----------- - ------ '------•.-�---------------------------------------------------------- ------ Phone__4k6. _a(op7-•--- Installation will serve: Residence Apartment House ❑ Commercial CJ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms Z--- Number of baths ---I--- Lot size ---SV—t---____1�S'----------------------- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 79 Hardpan ❑ Previous Application Made: (If yes,date_..-----------------) No 0 New Construction: Yes U' NoX FHA/VA: Yes ❑ No,K 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`1i4v_T•R__Distance from foundation-----L-0_l--------Mafyial-.------- r ------------------------ -------------- No. of compartments.______ ___________ S -X - 8- -- __ _l - -___ - ---------Capacityj40_.j Disposal Field: Distance from nearest well_-'7'L0_'A.--9_Distance from foundation_____�.Q__f------Distance to nearest lot line__--__-?__`--- Number of lines---------------`--r_-:------------Length of each line----_.'{O'..-_.---._-_...Width of french--------- SA _-..-----._-. Type of filter materiaI__S_.L_Rvf_K--_Depth of filter material-------t--C&C --.Total length------------------------- 4.1_---_-.-- Seepage Pit: Distance to nearest well_`1,N4-;- —___Distance from foundation-----LQ_'______.Distance to nearest lot line----b._f------- Number of pits----------I-----------Lining material..4�•___ c .Size: Diameter_____Vim' Depth----------------2„5�_'_____._ d Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------,----.-.-_- ❑ Size: Diameter------------------------------------ Depth--------------------------- ------------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------_-------------------------------Distance from nearest building-------.-_---.._.---------__------.---._. ❑ Distance to nearest lot line----------------------------------------------------------------- Remodeling and/or repairing (describe):--_--.-�.�s's`� '' ._-. _=0.._.___ --_ - r LA -----------••---•---------------------•--------------------•------•------------------------------------------------------------------------------------------------------ --------•--------•------------------------------ J ---------------------------------------------------------------------------•-----------------•-----------------------------•------...---•-----------------------------------------••----••---------------------------------- Q ----------------------------------------------------------••--------------•---------------•------------------------------------------------------------------------------------------------------------------- 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. .Q (Signed)------------------------ ----------- -=----------------------------------------------------------------------- (Oner and/or Contractor) B (Title}. Y•----------------- ------------•--------------------------•-------------- - ---`- --- ---------- {Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY If APPLICATION ACCEPTED BY ---- - - I- -P�.-------------- -------------------------------------------- DATE REVIEWEDBY------------------------------------------------------------------- ---------------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------- --------------------•---------------------- '---------------. DATE-------------------------------------------- Alterationsand/or recom endations--------------------------------------------------------------------------------------------------------------•------------•----------------------------------- ----------------- ------------------------------------------------------•------------------------------------------------------------------------------- ------- -------------------------------------- --- --------------------------------- FINAL INSPECTION BY:-------- ------ u - ------------------------ •- - Date.. ---6--- -7 -,---- . -------------- --------------- ---•--- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxslton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.ro.