10265 - Laserfiche WebLink

Home Browse Search

d / APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ;. Date Issued -- J Application is hereby made to the San Joaquin fLocal Health District for a permit to construct and install the work herein described. This application is made in compliancew unty Ordinance No. 549. JOBADDRESS AND LOC TION d-� � �------------------------------------------------------------------------------------------- Owner's Name--------------------------t---14............A_lU_. _ p /r---------------------------------------------------------- Phone- 113-----------------------------------!/3O S, ©L/ v� - - ----- --------- Contractor's Name-------------------------------------------- - --------- 4"- ------- 'f.� Phone Installation will serve: Residence K Apartment House E] Commercial Commercial E] Trailer Court E] Motel F] Other E]Number of living units: I--- Number of bedrooms __C____ Number of baths I___ Lot size _____-4-6_ Water Supply: Public system Z Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeyg" Hardpan ❑ Previous Application Made: Yes ,K No ❑ New Construction: Yes;K No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 'r (No.septic„tank or; l cesspoopermitted,.if,public.sewer,is available within,200,feet.)_ Septic Tank: Distance from nearest well-_____ ____.._Distance from foundation------� •-------Mater'al--- -_______._. No. of compartments._.____�`-------------Size----��__ �X. ___Liquid depth------- -------------Capacity......�-v__ Disposal Field: Distance from nearest well------------------Distance from foundation__ w_________Distance to nearest lot line____ _____ # Number of line's'-----•____-- ----- Length of each line----------- of trench--------2 'r' `--- �,,,,_. T pe of filter matenai____ _-___.Depth of filter materEal-- 19_-______Total'length_____________________________ .-••.,r,•�-.,°`-* � � �.t�'�a Seepage?Pit: DistanceMto nearest well__/___�: _______Distance from fou.ndation________________�DistanCe to nearest-iot line------.________._ I a❑ Number of pits ----Lining material-------------- '' ..Size: Diameter-- -----------------Depth------- --------------------- 1-11 p -- .- -.f�tan---------------------------------------------------fdation--------------------Lining`material------------------------------------- -'Liquid Capacity----------------------------gals. Cesspool: Distance from nearest well}-__-.___ _�_. istance ,,ram oun Size: Diameter_________________ ____ Privy:) Dtance ,rom Barest well_____________________ ________---------- Distance.,from nearest building------------------------------------------ T ] Distance to nearest lot line--------------- -- -------------•------------- ./-- Remodeling and/or repairing (de cribe]:_�_-. �t ---------------i------ - y - -r. ' " 'e�"'�-- _ 1 ------ -- ----- ---- -- -- !- - I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules nd regulations of theiSan Joaquin Local Health District. (Signed)-T - a ---- --------- -- - ---------------------------------------------a ------------------------------------------------(Owner and/or Contractor) -� ( P --- - - -- ------------ --- -------------------- -----------;-�----------------------- (Title) -' Plot la� owing size of lot, location of system in rellatiooi to'wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------- - -- ---- ------------------------------- ---------------------------------- DATE-------, .REVIEWED BY------------------------------ / - ----------- - B'JILDING PERMIT ISSUED----------------------------------- ----------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations---------------------------------------------- ----------------------------------- -------•-••----------•---- --------------- -- �- -------------- 1 ---- j ---- ------------------ --------------------------------- -- j r-P� Lr-- - ------- -r ' --, f ° ./Z—/�S FINAL INSPECTION BY:---- - -- --------- ----- ------------- Date. -- --- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American.Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES---4-2M Revises 1-57 F.P.CO.