17703 - Laserfiche WebLink

Home Browse Search

II �f°` -:-:---- �-•:=. APPLICATION FOR SANITATION PERMIT IPermif (Complete in Duplicate). / This Permit Ex ires 1 Year From Date issued x Date Issued .-�1-- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct a x This application is made in compliance with County Ordinance No. 549. I� and install{fihe work herein described. {� r J08 ADDRESS AND LOCATION_. 1- *7 ' !!(/ {i� + /� I Owners NameV, rl -------------------- - -- - Address----- 3....y `� - Phone.. ► ----- Contractor's Name----- I ^� C ----------------------------------------- 10. ---7------------------I------------- ------ -----------------------------------------_.. 4one----- their Installation ------------------------- -----•--•--- Installation will serve: Residence ------------------ ---- 4 Apartment House ❑ Commercial Number of living unit: _- _- Number of bedrooms :- ❑ Trailer Court ❑ Motel ❑ Other ❑ o ;Ili --- Number of baths -d`L l r Wafer Supply: Publics stem Lot size ._ ---.,rX_ I! Y ❑ • Community system •--•--•---•----------------------------- Character --•--------------•---Character of soil to a depth'!Mof 3 feet: Sand ❑ Private Depth to Water Table�ft. ' ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El—Cl-ay Previous Application Made: r If yes,date------ Y ❑_.Adobe❑ Hardpan ❑ TYPE OF INSTALLATION RIND SPECIFICATIONS: 1 No ❑-- New Construction: Yes ❑ No rrFHA/VA: Yes ❑ No I (No septic tank or cessP001 permitted if public sewer is available within-200 feet.) Septi ank:�hh Distance ;from nearest well------------- ---Dis#ante from foundation-_----- Material--- iI �I. Sept J No. o{ c Impartments Size------ ------ ---- Disposal Field: Distance from nearest weii_sr _- Liq id depth .:. _------:N Capacity-•--------------------- i Distance from foundation- 0 Distance to nearest llot line. ._f___ Number of lines-_-.-= _-_ Length of each line-- -c1__'r------_ Width of trench-_ ' _'_"_ Type of filter material- 6-_G ___ ---------- Seepage Pit: D Stan of filter material--/,----''_-__--_---Total length_M_g Distance fo nearest well.fpq___y- Distance to nearest to ^ " Distance from foundation_-fib..------_-_. Number of pi}�__ __ _Lining ma}eria�D C- ze: f � ' 6 - i Cesspool: Distance fi,om nearest well ----------------------------- .4. from foundation Diameter-- L�nmg ma}erDiapth �� is ❑ size: Diameter --------------------------------Depth Liquid CapaciEl -------- Priv ------------- ----------- -- Y� Distance from nearest well--------------------'-------- tY--------II--------------- ...gals. -------------------Distance ftom.nearesfi building E ❑ Distance tj nearest)lot line---------------- g-=..... Remodeling and/or repairing [describe):----------------------- 4 -------------------------------- --------•----•----- I ----- I: ----------•------ I ---- -- i l� - ----------------•------------------------•--------•-------- ------------------------ I3 hereb certifythat I have prepared this application and that the work will be done m accordance with !� ordinances, State laws and rules P d regulations of the San Joaqu n Local Health District. h San Joaquin County �� s (Signed)---- G"�C_P ---------- -- ---- - ------- -------------------- 1 ----- ---- {o By------------ w an Contractor) Ip g '11 -------------------------------------------------------------- Title----- - n Plot Ian, showing sae of lot, loca+ton of s stem to relation to wells buildings, etc., can be placed on reverse side). .; II +---------------------- 4 --- FOR DEPARTMENT USE ONLY I� APPLICATION ACCEPTED BY-: �._ ------------------------ :-------------------------- DATE--- _ REVIEWED BY-- �� '� BUILDING PERMIT ISSUED i ---------------------- ------------ -------- DATE ,,, -------- —, M Afterations and/or recommendations:_---- �� DATE--`------- ' �k ------------------ - -------- --------------------- -------------- II ------------------- i ----- ------------------------------- -------------------- --------------- : ----- ------- FINAL ----- INSPECTION BY: ---- : i I ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ehon Ava. If � 300 West Oak Streett 124 Sycamore Street P Stockton,California Lodi,California 205 West 9th Slreet Manteca,California I ES 9 REVESED 8.59 3M 3•'63 F.p.CO. Tracy,�ahf0rrlla II it 11