11352 - Laserfiche WebLink

Home Browse Search

APPLICATION FG. . SANITATION PERMIT Permit No. __1/_3 . (Complete in Duplicate) � V` Date Issued _`____1_.. Application is hereby made to the San Joaquin Local Health District for a"permit to construct and install the work1erein described. This application is made in compliance with County Ordinance No. S49. DIV wormKs q1b� WOSF- . L� Q1V IV d 5►D!E JOB ADDRESS AND LOCATION- - -=-�--I---J!3-8.....RE7NGH -------- --- -- -- Owner's Name-----------FoyD------- - --- - ---------- -------------- ---------- Phone------------------------------------ Address--------•------------------------A13D.v-F----------------------------------------------------------------------------- --------------------------•-----------------------------------------------•---- Contractor's Name---- --• ----- ,(--------------------------------------------------------------------------------------------------------------------•---- Phone------------------------ _ ---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ..M``otel E] Other E]- Number of living units: - -_.._ Number of bedrooms _'--Number of baths --1____ Lot size ------.lam P---K,___T1____________________________ Water Supply: Public system ❑ Community system Private P- Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ ravelr�;- rs y Loam Q.yClay Loam ❑ Clay ❑ Adobe 6 Hardpan ❑ Previous Application Made: Yes ❑,No �New Constr�f�i6—Imes,l No ❑ FHA%VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool pertmitted if public sewer is available within 200 feet.) Septic Tank: Distance from neatest we{f__`_________ Distance from foundon_________ ati _________ Material------------------------------------------------- No. of compartmetlts------------------------I Size----- --------------I----------Liquid depth--------------------------Capacity----------- ------ #Distance fr©m�. y 5 Disposal Field: Distance from nee est well_'-�____i �ou l�da�ion___.�__�____�_____.Distance to nearest lot line___-_J.__.____. Number of lines-----------------------------------Length of ea6,line fZ57_n_5__~"1j&-Width of trench___- j��__________________ Type of filter material5.__9QC_W,__Depth of f�tl#�rwrxaat x�l___/g_____.........Total length---------44________________________- Seepage Pit: Distance to nearest well______________ ----------------------Distance from foundation___________________.Distance to nearest lot line_______..________ � ❑ Number of pits----------------------Lining material---------------- Size. Diameter-----------------------Depth--------------------------------- V3 Cesspool: Distance from nearest well-----------------Distance from f unclation----------------------Liningmaterial-___.-------------__-_ _---_---. (!� (] Size: Diameter--------------------------------------Depth--------------- ------� --------LiquidlCapacity- ------ ---------------� •gals, i Privy: Distance from nearest well .------------------------ - _---------- ------------- ---Distance from nearest b;;uilding_ _- _ ___._ __________•------ ---. ❑ �.... Distance to nearest lot line------------------------------- ------------------f----------------------'�--- - ----- ------ Remodeling ---r------- --------------- --------- Remodeling and/or repairing (describe) __4 ► .. ------------------------------------------t-------------------------------------- I-------+,b ----------------------------------------------------------------------- ----------------------------------------- 1 T W -0 __________________________________________________________________________________________________________________________ ______________________ ________________________________________________________________________ --------------------}-------------------------------•------•----------------------- ---------- 3 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan S, State laws, and rules,and regulations of the San Joaquin Local Health District. (Signe - � �C. �.Y.�-tee t 1 ' i ---------------------------------------(Owner and/or Contractor) --- ------------------...-•------------------------------------ ------------------ ----- By: (Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY IZ f? ----------- DATE------A-I-7/5- ------------------ APPLICATION ACCEPTED BY---- -�.----'---'---------------------------------- --- ---------- --------- REVIEWEDBY-------------------------------- ------- --------------------------------------------------------------------------------- DATE------ ------------------------------_-------------•------- BUILDINGPERMIT ISSUED------------------------ ----------------------------------------------------------------------------. DATE------------------------------------------------------------- Alterationsand/or recommendations-------------------------------------- ---------------------------------------------------------•--------------------------------------------------------------- ----------------------------------------------------------- -------------------------- -------------------------------------------;�---------------4---------------------------------------------------------------------- --------------------------------------------------------...------------------------------ -- ---------------------------------------- _=--------------------------------------------------------------------- ----- .-- -------------------------- ------ - ----- ---------------------------------- ------------------------------------------------------------------------- ---------------- ---------------------------------- -- ---- -------- -----------------------------------------------------------------------------------------•------------------- /"FINAL INSPECTION BY:--- f 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 , Revisea 1.57 FY.CO.