11077 - Laserfiche WebLink

Home Browse Search

t t ciw� Permit No. _fl _- APPLICATION FOR SANITATION PERMIT ._.. (Complete in Duplicate) 3/S p Date Issued Application is hereby made to the San 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. JOBADDRESS AND LOC TION - �.. ----- ------------------------------------------------------------------------------ Owner's Name------------------ ---------- --�--- -----•--------------------- - - ---------------------------------------------- Phone---------------------------- ----- � r -/- --- �------------------------------------------------------------------------------------Address te- P '157 - :. Phone.-Name-----------� c - } Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ___Number of baths -1----- Lot size ------40 "-,y J 1A---------------------------- Water __- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table?/. ft. I! Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ CI"ay Loam ❑ Clay E] Adobe , <ardpan.F] Previous Application Made. Yes ❑ No New Construction; Yes [ /No U FTA/VA: Yes ❑. Nn ®— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well,-* Distance from foundation__-/Q__._'_-_.Material---- CC__ Y4_C_-___-- - No. of compartments------_2.�-----------Size-- '�--�(• -- ---Liquid depth----�%�------------Capacity__ 09 ---'----- � J: 1` Disposal d: Distance from nearest well - istance from foundation__1�____.______Distance to nearest lot line---S'__________ Number of lines---------------f------------------Length of each line------�----------------Width of french----- n2J-1_'_----------------- Type of filter material___Yo-,�_j---_---_Depth of filter material--_fig.__..........Total length_______,�1_Q____________________-___._- See pag tt: Distance to nearest istance from foundation_-- ___________Distance to nearest lot line-d---._.......... i Number of pits-----/-------------Lining material--')°C1r--------Size: Diameter--+33__1.10----------Depth--.-)-,5__/------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-_._______.______-_---------------_ !F ❑ Size: Diameter---------------------- ------------Depth--------------------- ------ ----------------------Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest well-------------------------________________________Distance from nearest building---_-----.--------_--_-______________-__. ❑ Distance to nearest lot lire-------------------------------------------------------------------------------------- ----------------------- -------------------- ------- Remodeli and/or repairing ( �scrib = t� f �"L ` � 'Lr,�' = ---- --------------------------------------------------------- -- ---------------------------------------------- -----------------------------------=------------------------------------------------- --•----------- ^_---..:_ 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 District. (Signed(--------------------1 7p rrr`«--- -- ---n------------------- - -.(Owner and/or Contractor) By:---------------t•----•• d .w/ Lr✓ ------ -11 -----------------------------(Title)--.---- � `? --- (Plot plan, showing si lot, location of system in.relation to wells, buildings, etc., tan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------ -- - --- ----- -- ------ - --------- DATE_--- REVIEWED BY----------------------------------- DATE------------ --- --r�------f----------------------- BUILDINGPERMIT ISSUED------------------------------- '------------------------------------------------------ DATE--=---------- ----------------------------------------------- Alterationsd/or r mendations-------------------------------- ------------------------------------------ --------------------------------•--•----------------•----------------------- ----------------- ------------• - --------- •-- ------- =! -- ------------------------ -- ------ - - ------- ---------------------------------- ----- -- ------ --- - -- j --- --- ---: - � • --------•-------- -- - ----- - --------- ......."4-.h.................. ........ � � FINALB -----------------' -•- -------------- - •----- Date---- ------ --------------------------------------------------------- SAN ------------------ ------ -- - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT Y 130 South American Street 300 West Oak Street 132 Sycamore Street` 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised ).57 F_P.CO.