20987 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r - ------ -------- r-- --_ -.._.______----..___-__- APPLICATION FOR -SANITATION PERMit Permit No. c -- - --- ---- - - � ---� ------------- ----w, .,.,. (Complete in Duplicate) - ---.--- This Permit Ex ires 1 Year From Date Issued "Date issued .x7,_/2...4^ k/, Application is hereby madeto the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This applicatior�is made in compliance with County Ordinance No. 549. /1 JOB ADDRESS AND LOCATI N______--�j n JrJ_' (ffJJJ --------------------- Owner's NameSA-74 ---------------------------- Phone----------..::_ _ - - ------ ------- -------------------- Address t&d------ --- -- --------------- ------------------------------•-----------•----- Contractor's Name --------------------. Phone.................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other � �-Q Number of living units: _fir Number of bedrooms$ -_._ Number of baths -- `Cot size - --- ---- ---------`�-�'.�-,7th �. Water Supply: Public system ❑ - Community system ❑ Private Depth to Water Table '_._ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ' Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date........... ........} No [ New Construction: Yes Na ❑ FHA/VA: Yes ❑ No [�( TYPE OF INSTALLATION AND SPECIFICATIONS: ( P P P ithin 200 feet.) ' Se tic Tank: Distance from nearest well C�---;Dist fro o - o septic ool- ermitted�if-public sewer-is avertable-w _ p unon- ! Q-- - M aerial---- - ----------------------- No. of compartments__---- - Size _ - _ `f qq Liquid depth- -- -- - ------Capacity_'_1_�71 j Dis osal Field: Distance from nearest well.__70----__Distance from foundation-___�'1 -------Distance to nearest lotNumber of of lines-----I............. g I ----- fen th of each line------- ---- �_---Width of french-----/�.� ________•-- , Type of fitter material___.S_ } Depth of filter material---_-1--�---------Total length____________ __l _ __•- 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_______..___--.__._ ❑a ..__ Size: Diameter - ----- ---------------- De th . «:Depth-=----------- -------:j:------ ----- ------Liquid Capacity ----gals. � R Priv .� t - ,..,.. Privy. Distance-from nearest well _____---------------------------------------Distance from nearesf building--------------❑ Distance to nearest lot line------------------------------------------- - Remodeling and/or repairing (describe}:_-._ 5 -- .-----=--- 9 --•-------•------•------------•--------------------------•-------------------------------_ -------------------------- -----------F----•--------- ------------ --------------------------------------------------------------- --- ---------------------------------•--------- --------------•-------------------------------------------------------------------- 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 Distric - 1 r' (Signed)- ---- e.,__ --- ----- ------ -- � . --- ------ -(Owner and/or Contractor) -Vj - -----------11---------------------------------- ___ ti� J -= ".�"{Tit a--:-- (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 APPLICATION ACCEPTED BY------------------- ----------- --------------- DATE --------- ------- REVIEWED BY---------------•------------------- ------ --- DATE- --- -------- BUILDING PERMIT ISSUED___________________________ — ------------------ DATE------------------------------ Aaerations and/or recommendations:_-__--.______ _______ `" •' ----------------------- -------�--------------------•----------------------------------- --------------------------------- ----------------- ------------------------ ---------------- - --- ------------------ ------ ------------=--- - --- --- -------- -- FINAL INSPECTION BY:.._____- / - ---•---` ---------- ----------- ------- Date L.--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED n-59 3M 3-'63 F.P.[:D. '