8974 - Laserfiche WebLink

Home Browse Search

Permit No. .; �. APPLICATION FOR SANITATION PERMIT l ' (Complete in Duplicate) Date Issued .--- � -•�- A Gcation is hereby made to the San Joaquin Local Health DINoc549.a permit to construct and install the work herein described. PP This application is made in compliance with County`�Or inan /�`�`- — ------------.---- ------- JOB ADDRESS AND LOC ----------- --------------- ' f � ----- ------=------- - - ------ Pone--•--------•---------------------•-- ------------------------ --- Owner's Name---------- r -----------•------•----•---- - ��----- --- ---- Address----------------•-------•-----•-----------•----------- - . ------- r . -------�- Phone----_---------------------------- Contractor's •---- -----Contractor's Name----------------------••------ -----------------•--------- - - ----------- Commercial ❑ Trailer Court El Motel ❑ Other ❑ Installation will serve: Residence VApartment House ❑ Lot size _-_-_-,.fJ - --1-43--------- Number of living units: ,__�-- - Number of bedrooms � Number of baths i 9 Private De th to`Water Table ---------ft. Water Supply: Public system Community system❑ ❑ P Sand Loam bClay Loam El E3 Adobe Hardpan C1Character of soil to a depth of 3 feet: Sand E] Gravel F1Y ^ No Eli Previous Application Made: Yes E] NoK New Construction: Yes �. No 171 FNA/VA: Yes [j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or"cesspool permi#ted if public sewer is available within 200 feet.) ' Septic Tank: Distance from nearest we}l_«-.-----_Distance from foundatiLn uid de th-- at-'- -----_---Capacity__..(3__�-q...... No.,of compartments---_ ---�---- ---Size__-.----/-X - q P. Disposal Field: Distance from nearest welL..��___-Distance from foundation_ "� -_----Distance to nearest lot line--.-__S._._-__. Number of lines------------- - -- ---- --'Length of each line------------------------- Ty of trench----------t .:' -r------- T e of filter material .__- - '4Depth.of filter material----------/.8------Total IBngth----------------j/0_;2------.--••• .: ..- YP ,�/ Pit: Distance to nearest well L -------- SeepageDistance from auk on-- °-_a_______Siance to nearest lot lime--- ----------• ize: Diameter-----------------------Depth-4-AA., epth- A.,------------------- Number of pits-:- -1---- ------Lining material A ool: Distance from nearest well----------------- fro foundation-__-- Lining material-------_.-_-------------- ---els. ❑ Size: Diameter---- ---------------------------- fDe th--------------- ----------Liquid Capacity------------------------ --g ----------- -- ----- - -- --------------------------------Distance from nearest buiidin ------------------------------------ Privy: ---- ---- ------------------- ---.---- 1 c i Privy: ... Distance from nearest well_ Distance to nearest lof:line- ....... ---- Remodeling and/or repairing -[describe):-------=----------------------------------------------•------------------------------------:'._.t ---------- -------------- --------- --------------- - - - - - --- ----_---------------•----•-------i --- . 2 _ -----•------------------------------" --"-5 ---- -- . certify that ! have d preparethis application and that the work will be done in accordance with San Joaquin County hereby { 4 ` ` he San Joaquin Local Health District. ordinances, State. laws, and rules and re ulations of t 9 (Owner and/or Contractor). (Signed)---- -- -- �-------- ------- --------- --------- -------------------------- --------- - ----------- (Signed) --------•----V � ------------------- - -(Title)------------------ ---------------------- (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). L FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY--------------- -- -- --- - ----- DATE------------- ------------------- d ----------------- DATE ----------- --------- -- REVIEWEDBY-------------------------------- --------- • ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------- = - - Aiteratiorls„ n� r recd endations:- ---• ---- -- ------------------- Le ----- -------------------------------------- 4;a " 7 ----------------------------- - --- - - ! -- - - - E - -- ---- ------- ----------------•-- - _-_-__----_._-----••"--- -- -___-- ---- _ _------___'--------•----- -• - ---- -----------• I, ell i --------S .._ ---" --------------- k Date_- -. - --------------------- FINAL -INSPECTION BY: SAN JOAQUIN LOCAL-HEALTH DISTRICT 132 Sycamore Street $14 North "C' Street BO South American Street 3U0 West Oek Street Y Trac California Stockton, California Lodi, California Manteca, California Y LS-9-2M , Revised 1.57 F.P.CO. —^i