13459 - Laserfiche WebLink

Home Browse Search

531----,s"/6 r /al r c �,- PPLICATlON FOR SANITATION PERMIT Permit No. ..... 1. __?`_ � (Complete in Duplicate) ' This Permit Expires 1 Year From Date Issued 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 Ordinanc No. 549. JOB ADDRESS AND LOtC ATIO J- �� ' - -- , —"� ��- G/ ` Phon lJp_ �Q--------------------- -------- ------ ��-.Owner's Name Address--------------------------- ---------------------------- --------------- F-0------- �` _ P---! Phon Contractor's Name JJ4 t ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M tel ❑ Otherg&.,) Number of living units: *!...... Number of bedrooms __Number of baths _.j._ Lot size --- /_________-,l _x._J Water Supply: Public system�Community system E] Private ❑ Depth to Water Table _.GVft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam-El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ I No ❑ New Construction: Yes ❑ No FHA/VA: 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 w II_ O.A—e-Distance from foundation___ C!-----Material------ ------------------------ ______________ W No, of compartents ___-------------Size5 _� ryr *.--Liquid deph_,.;�y�►__..____Capacity.-jQ -Y --r i Dispo I Field: Distance from nearest wefi.�0_ne-Distance ti�om foundation___I__ -- Distance to nearest lot lige_______ _ Number of lines. _______ i Length of each line-,13 .Width of trench_____;;t ----- .... of filter material_____ __ _��J�__Depth of filter materia ---------- o g pv d ------ _Total len th___ Q-'�___-- -- --'_---/ i Seeps e Pit: Distance to nearest well_N-VAIe-------Distance from foundation--Z0.-..---.Di ante to nearest lot line--�----_ Number of pits-_ __.�_____________Lining material_ a- lo- .__.Size: Diameter__--' -"__Depth__- f_._________ Cesspool: Distance from nearest wail_____________.__Distance fromundation__________________.Lining material__._______.._______.___---_-_________- N ❑ Size: Diameter.- I---------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-----_---------------------------------_ r ❑ Distance to nearest lot line---------------------------------------------------------------------•--•- Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------ w = ------------------•----•----------------------------------;- ------------------------•---•----------------------------------------------------- ----------------------------------------------------- I ---------------------------------------------------- ---------• --------------------------•--------------------•-------------------------------------•-------------------------:--------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e la and rules arilregulations of the San Joaquin Local Health District. + }� t � � (Signed}-----l- -------------- ��-� 1.�.�') ----�-- --t-- UC--t-- --- ---- ----- -- - - --------------- r Contractors , ------ -- --- - By ----------------- --- -------- - - - -- ---------- {Title)-- ------ - ------- ----- ------------------ -- --- (Plot plan, showing size of lot, location of system in relation to bui dings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY ,y APPLICATION ACCEPTED By •--- --- -- - ------ '°- sr ------------------ DATE---- c csr ir' REVIEWEDBY ` ------------------------------------------------- ------------------------------------- DATE------------ BUILDING PERMIT ISSUED-------------- I------------------------------------------------------------------------------------ DATE Alterations and/or recommendations •----------------------------------------------------------------------------------------------•---------------------•-------- I -----•------•------------------- --• --- -----•--------•------ •----------------------- --------------------------------------------------------------- ------------------------------- ------------------------------------ ----------------- ----- � yr FINAL INSPECTION BY:.._____--- —U -- Date--------------� ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised S-'59 r,P.cc.