9501 - Laserfiche WebLink

Home Browse Search

A. v APPLICATION FOR SANITATION PERMIT Permit No, yS_.Q_Pf (Complete in Duplicate) _ 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 Ord' ante No. 549. 4 JOB ADDRESS AND LO Alf N�__ �� } - --- ®- - ,� Owners Name----4_-.r ---------------- 1 �.P7�� ---------------------- ----- - ---- Phone---•----- Address------•----- �,i�f�.-----=. ----�m - - - - -- ------ - - _------------- Contractor's Name--__"__.__ - � .. � ------- -------- •--• ,��• --------------------- Phone Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ Number of baths _f--- Lot size Water Supply:' Public system ' __- s - Y s stem ❑ Priva#e" Depth to. Water „ II Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Foam p Clay ❑ Adobe ETRardpan ❑ Previous Application Made: Yes ❑ No P"New Construction: Yes P"-. Mo ❑ FHA/VA: Yes ( IQ� ❑ j i 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 :_____ e op Disfianee from foun anon_"" -- 1 d / ---------- No. Mate is I of com artments-_ 2 p �:=-�=�--��-�-=-Sae_��-•�-�Q-----Liquid depth---�� ----�t---- -------Capacity....��!_�_ �~ Numbee from nearest well---- _ -;-,Distance from foundation---4_-_�_------Distance to nearest I t lin a Disposal. Field: Di�tancr of lines_-_-_�__--_: _Length of each line____-o.��-__-__:___---.Wid#h of tren ___ ___� ___ I T ch----W ''-I Type of filter material/',y 'Depth of filter material-__� f! ° Total length. ----- -� f Seepage Pit; � Distance to nea est well_-� :"^_-„�_:--Distance fro fo dation"- ___ f Number of its-f-"- Arl _ _ size: Diameter to nearest lot line--.W "--_ p , + -Lining material, Depth Cess ool: ----.Lining mateal -----.��----------------•------' - p Distance from nearest well__-_•-___"_---�-Distance from foundation____._-_._--_. ❑ Size: Diameter ----De th------------------------------------------------------ I PLiqurd Capacity- -------------- --------gals. Privy: Distance from nearest well---------------"- _ ------------ .-•Distance from nearest building El Distance to nearest lot line____ i Remodeling and/or repairing fdescribe):--------_-- /— { ----------- --------- ----•--=---------- -&_ _ - ------------- - - -------------------------------------------------------I----------------------------- -- ----------------------- ------------------•--- -----------------------------I------------------ -------------------_------------------- ------------------------------------------4--------------------- I------------------------------------------------------------------------------------------- ---------- ---------: I hereby certify that I have prepared this application and that t ordinances, State laws, he work will be done in accordance with San Joaquin County and rules -and regulations of the San Joaquin Local Health District, 4 (Signed)---------- ----• -- -------- - ---------------------- BY=------------------------------------------------ � �� n rat Contractor) -------------- ? " (Title} [Plot plan, showing size of lot, to on of system in.relation.to wells, buildings, etc., can be P-laced an raver side].---------------------- { t FOR DEPARTMENT USE ONLY I� APPLICATION ACCEPTED BY-- ----------------------------- ------------------------------------------ ----- DATE REVI EWED Y_____ "__---;---_ -- --- REVIEWED BY = ATE -� ------------- -- BUILDING PERMIT ISSUED------- `-- DATE = - ------------------------------- ----- Alter tand/or recomrriendatians: - - DATE = ----------------------- ions 454 ------•-"--•----------------------•------' - T-t---•-- .Jed �, ,�� ._� c = �� -------------- --------- -----•-------- ----------- ------------ ---------------- -------------------- - -- ---- FINAL INSPECTION BY-------------- ------------------ Date------ `1':77 ��- a _�_S ------------- N JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American stree} j 300 West Oak Street 132 Sycamore Street 814 North "C" Street X Stockton, California Lodi, California Mentaca, California Tracy, California ES-9-2M , Revised 1-57 ERCO. I