19900 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: SS 5/ 11 APPLICATION FOR SANITATION PERMIT Permit No. 1. �a ... ---------------------- ------------------------------ (Complete in Duplicate) Date Issued ---------------_--------------------------_-------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the Son 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. l ' , ---'--- JOB ADDRESS AND LOCATION---- ---- -------------------- -------------- r'Owner's Name-------- l ---------------------- - - ---------------------------------------- Phone Address ,0' , 5/--......TIVI-4C�t---G�4G/PD/��111�-------------------------------------------------------------- Contractor's Name.__ _=.P ��cr "P ',-16 ^Gd �.� c.f-Phone---f s _v I)9---- Installation will serve: Residence ) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _3_._ Number of baths -------- Lot size _ _d_--- __.----------------------- 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, , Hardpan ❑ I Previous Application Made: (If yes,date....................} No if New Construction: Yes No ❑ FHANA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellD_a Distance from foundation..1 �- MitY ___________________� Nom -----------Size- ------- --Liquid depth---- ----------- CaPa❑ ,1 _ _--•-- Disposal Field: Distance from nearest well./�- _55.-Distance from foundation___?�----- t_J)istance to nearest lot line__:~ ❑ Number of lines_____ ______.)______________Length of each line__ __: ____- Width of ______________ Type of filter material-_S--r) Depth of filterCCma lad_' _'r -�otal length_-___ a_ .._____________.___ 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 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----------------------------- ------ -------- - ----------------------------------------------------------------------------------------- - Remodelingand/or repairing (describe):--------------- '---------------- -------------------------------------------------------------•------------------------------•------------------------- --••-----------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------•--•------------------------- ` ------------------- ---------------- -. . - 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. f W_A-Lis-tom- 7)3 .li�c� ------------------ Owner and or�Contractor (Signed) j - , ( ) �/ / `" (Title - ---By:- i � c'w't', ''` =- -------- - - ---- - --- ---•--- ------------ ---- ) �� = (Plot plan, showing size of lot, location cif s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY--------------------- ------- --------------------- ---------------------------------------- DATE---------------------------------------------------------- - REVIEWED BY------------------------------------- ---------------- ---------------------------------------------------------------------- DATE----------------------------- ------------------------------ BUILDING PERMIT ISSUED- .._--•-----•--------------------------------------------------------------------------------------- DATE----- ------------------ ------------------------------------ iAlterations and/or recommendations:-------------- ------------------------------ ----------------------------------------------------•--•-------------•-••------------------- ---------------- I -----------------•-------------•--------------------•------•--•-----------------------------_------------------------------------------------ ---- - ------------------------------------ ----------I------------- ------------------------------------------•-----------------------------------•-------------••-------------------------------------------------------•---....------------------•--------------------- ---•-•----------------------------------- -- ----- ------- -------------- ------- ------------------------- --------------------------------------------------------••--------------------- -------------------------------- -------------------- ------------------------------ ----------- ......... -----• ------------- ----------------------------------------------------------- -------------------------------------------- FINAL INSPECTION BY------- - ---- � �� A?6_// Date-------- --------------------------------------------------- SAN SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelion Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8-59 3M 3-'63 F.P.CO. '