13511 - Laserfiche WebLink

Home Browse Search

------------ ------------I------------------------------------_------ f APPLICATION FOR SANITATION PERMIT Permit No. .. �....`............. r. -------------------------------------------- ------------ (Complete in Duplicate) -1L This Permit Expires 1 Year From Date Issued Date Issued ... ..............._ Application is hereby made to the Sen 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. " P o_.AJ'` _ JOB ADDRESS AND LOCATION..............•.- � - �.. rte'._. S...Ci •• _....-----•...................... Owners Name......... n to R -- -- - ---��------.�5_�-------------•-�--�--------•--=---------------- ----:-----------•-----------------------... Phone-------�--�-�--�-�� .��-:�:�' Address -------------- e9 ------------------------- Contractor's Name_--------------_----jj_-I.F_.----------_----------- ....................................................... --• :...---------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: ---/-_ Number of bedrooms ._t - Number of baths -------- Lot size _____----- ?r 1 ___11_Y X_a ..e--_:__-.------ i Water Supply: Public system ❑ Community system ❑ Private 2r Depth to Water Table .. 9ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If ye',dote--------------------) No Q New Construction: Yes No ❑ FHA/VA: Yes 91 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-.--_;Q_4-Distance from foundation.....Za.--------Material_--- �£ \ No. of compartmen#s---•------- ----------Size. {. --- Liquid depth--------' /------•-----Capacity_ I Disposal Field: Distance from nearest well----... Distance from foundation....lG_ ...---.Distance to nearest lot line....... G Number of fines_. ..---.:-------- --------------Length of each line.------._--•75..7--------Width of french--------- Type of filte�KmSteriel CC-------Depth of filter material---------15'"_`_------Total length.............1..�..g_ -_-.. . Seepage Pit: Distance to nearest well=----/t2 -�{---Distance from foundation------/.v,_-',-__.pistance to nearest lot line.-__---J.�.._ ® Number of pits---------�----------Lining material-_- - / ------Size: Diameter�,�h ---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--------- - Remodeling and/or repairing (describe):-L------------------------------------------------------------------------ ------------------------------------------------------------ , i ---•----•----•-•-------------------------------------------- . -.:f-- -----•--------•------•----•-----------------•--------••---------••--••--------•---------.------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed�_.X_ -- � L� •-- --------------•-' and/or Contract / n BY:- = - --------------------------_-- (Plot I Title (Owner d/o or] -------------------- -------- -----------------•--------------------..:-_-- ------------------------� --��- r • } - ---------------------------------- (Plot plan, showin size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR.DEPART ENT USE ONLY APPLICATION ACCEPTED 6Y.----- - ---------------- -------------------------- DATE...------- �� ,�� Cf`{ REVIEWED - -- .. DATE---------------•---------------------------- BUILDING PERMIT ISSUED----------------- -----•--------,-...-- -- . Alterations amd/orrrecommendations:.- E--------------------------------------------------------------g t .- --- --------•--_- - -----•- •----•-•---------------•- ------ rt. _ f � - e - !.� �GZ-S.�c,�.'..�tii:----• • � --•---�-,� -'-----�'4°kc----i..---'�7,��- -- -- --- --.��j�----1�•Z`•�a,�.,-- - �'�"-- - -- •-- ------�' --:�- . .-Cil .'-. ,f.- -�.-A •------------------•----------- ----- ------------ FINAL INSPECTION BY:.. s ,------ ------ -- ODate F 'll•!--- -'- ------- SAN JOAQUIN --••-_SANAQUIN F LOCAL-HEALTH DISTRICT 130 South American Street 300 WocF Oak Slroof F 124 Sycamore Strout 205 West qth Street t Stockton,California ; Lodi,California Mantua,California Tracy,California r EB 9 REVISED 8-99 IM 'J-Ef A71LAB