14105 - Laserfiche WebLink

Home Browse Search

?l/ G- l' APPLICATION FOR SANITATION PERMIT Permit No. ..,a.-7'- Q_ ------------------------------------- - - _ _, (Complete in Duplicate) This Permit Ex iter l Year From Date Issued Date Issued _JM Application is hereby made to the San Joaquin Local Health District fora permit to construct and instal!the*work herein described. This application is made in compliance4with County Ordinance No. 549. g—g, / S= JOB ADDRESS AND LOCATION?It t . ' ----- c, . fir- . �. Owner*s Name------. + n �j ,�u • f�� !!U1-51-/ _.-0 ne. - Address -�_�� 47'7.1 4,441 i Contractor`s Name ---------------------------------------------- - ------••----•------- - --- ---------•-- l: --- 1. .11 s ------------ g------- ``.-.-." Phtone f�•- 1'�&�j4V Installation will serve: Residence ❑ Apartment House ❑ Comtnercial' ❑ Trailer Court []� .Motel E] Other Number of living units:. -- Number of bedrooms ___-__-. Number of baths __... Lot size _ t9 _ -•-__ ____ . , Water Supply: Public system Communi s stem i. tY y ❑ private ❑Depth to Water Table, ,.�ft. Character of soil to a depth of 3 feet: -Sand ❑ Gravel ❑ Sandy Loam j] Clay Loam J Clay ❑ Adobe ❑' Hardpan ❑ y �" a Previous Application Made: (If yes,date'-`.--_.--------------) No'$ New Conestruction Yes "'No'❑ € FHA/VA: Yes ❑ No W TYPE OF INSTALLATION AND SPECIFICATIONS: a" (No septic tank or,cesspoof permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_A4A)e_Distance from foundation- No. of compartments------ Size.�..." ----------Liquid deph-- - -/-1- -----------Capacity.�0p0._T4Disposal ........... e Field: Distance from nearest well__N0497.Distance from foundation..�Q __--- ---.Distance to nearest lot line-Z42 �. Number of lines___--- Length of each line---'__eta- Width of trench-24-4-F-1 Type of filter material-�- __ p°l,� _Depth of; filter material_ _. -_ - f --- ` -------Total leng#h._'.-.-•�-��---------------------- Seepage Pit: Distance topes well__NQ_ _T-----Distance from foundation___L- .. -; :-- a,ce to nearest lot line-1� ; Number of its.: .,_ (�_� ------Lining:.ma'fierial-_��?��'�.-----Size: Diameter-`____ -___ -_ - -----.Depth----•S---------- ------ Cesspool: Distance from nearest wail------ from foundation_--.---__I----'_-_.Lining material-------------------__--_-----. Size: Diameter---------------- ------ Depth ---------- -------_Liquid Capacity -------gals. Privy: Distance from nearest well---- i . . . ._---------_Distance from nearest building------------------------------------------ -------- _______--_•_-_ ' • Distance to nearest Iot•line__-______._•"_-.________ -- • ''�"" ---------•------------ - --------------------••-------•-----------n ---- Remodelin and/or repairing (des i. , ------.-----••-----•-- - ]---•-- ---- E =-- ----------- ----- f� Qr ---------------'--------------------------------------------------------------------- r ------ -------- -- --------- - •-- ----- hereby certify that l.hb-t prepared this application and`that the work wilf'be done-in accordance with San Joaquin County ordinances, State laws, 4id r s and}I4regula#ions of he Safi Joaquin Local Health District. ( M (Signed) �., ------- - $ �--- -- - �----=---- =-=---------• ---------------------r( caner and/or Contractor) Y------------------------- - -: - ;�` ------- .°---------- :.. = ..(Title) �. �Q- =..--- . (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced reverse side}. FOR DEPARTM NT USE ONLY s APPLICATION ACCEPTED BY_ f ---- --------- - ----- ------------------------------ - --�------------•-- ---...--- ------ DATEREVIEWED BY-, BUILDING PERMIT ISSUED------ --- DATE-------------------------------- _------- ----------------- , DATE Alterations and/or reco mendations:_-_ - 4 .3.Q---� ._ -. >�_- -- - ---------------- -- --- -a FINAL INSPECTION BY:- _' - Date_-"__-;_ �Y 1 --------- -----:------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 12 4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,CaiiFornla EC•9 REVIBE6 8-39 F.P.0 C.2M 6-60 Tracy,California ��_4