11820 - Laserfiche WebLink

Home Browse Search

9 ' } APPLICATION FOR SANITATION PERMIT Permit No. ..11 ._ (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a perry it to construct and install the wgrk herein described. t This application is made in compliance with County Ordinance No. 549J �2s3 / JOB ADDRESS AND LOCATION_ _ ?- j " --- --------'-------- ------------------ --------------------- Name •----- ---- ---- = F - 1 3 Owner's Name------------ `'fi r - --------------------------- ------ -- -------''--s--- _` -- --- Phone-----------•-------•-••-----•-•--- Address---------------------- =----------------�--91----- r-� (. '" -_— ----••------------•--------••--••---------- -•-----•- Contractor's Name__-i -----^°'--" ----------+------------------------------'--------------------_- -----------------=---- Phone-----•------•-------------------___ Installation will serve: Residence E-Apartment. House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___-____ Number of be Number of baths __ ___ Lot size _l F,�. __.. _ -__ -_.__ 1 :7--- r Water Supply: Public system ❑ Commun'ity:system ❑ Private �pth to Water Table::__ ft. " Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ - Clay Loam ❑ Clay'-[] Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FkA/VA: Yes;E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I , (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) s Septic Tank: Distance from nearest well_!5 a.o_w Distance from found�ation__� - Matgr al---_ -- No..of compartments------ ____.---------_Size_ ______3_X___ ___Liquid depth__.____ __ - Capacity,_ �:d--_- Disposal Field: Distance from nearest well_ -7-4)1`stance from founclation_1 __` Distance'fo nearest lot T 'Number e of filternmaterial_: _F_ �De thhofffilter1rinlaterial______f: �t______Total ,length__-.__-.3�-_T' �:---- -- g �___ ___________Width of trench---� -3b- Type P ------ --------•- Seepage Pit: Distance to nearest well___________:__ ___Distance from foundation-----_________•____.Distance.to nearest lot line__-_--________--_ l ` ❑ Number of pits --._-Lining ma#erial-----------------------Size: Diameter----- `-Depth . ..,,. Cesspool: Distance from nearest well---------------:=Distance from foundation--------------------Lining material_ ----------__________'_____-___-- 4 ❑ ... Siz#e: Diameter--- --------------------------------De th-----------------:-------- -------- --------------Liquid Capacity----------------------- Privy: ----gals. Distance from nearest well * * ----------- Distance__ Distance from nearesf building_= i---------------------- --- -------- ❑ Distance to nearest-lot Line.-. _ ----- _ --- � � -� ' — _- ------------------------ ------- - -••------•- -------------------- ---- - Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------ _.............•---------------•-_---. # o - - = :- ----------------------- - _ f � f ---------`------------------------'------------------------------------------------------------------`---__-----'----=---`_`•--------------------`---_—___------------------------------------•------•-------------- I hereby certify that Fhave prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re tions of the San Joaquin Local Health District. I } (Signed .�»-„ cc''�__________________F Owner and/or Contractor ) s --------- ----------------- - + / ) I By:' -- Ti+le t l Y• ---•- _ - ° Plot lan, showin size of lot, location of s stem-in relation to'wells buildin s=etc.,,can be laced on reverse-side— 1 ' � �® PA TME N ,USE O a APPLICATION ACCEPTED ------------- REVIEWED -------- - -- f� --- REVIEWED BY_---------- --- --------------- ----------------------- --= ------------------------------- --------------------- DATE.-------------------------------•--- -------=----------- y ' BUILDING PERMIT ISSUED-----------------------------------------------`------------ -------- ----------------=----------- DATE--------------------------------------------------------------- Alterations and/or recommendations: -------------- ------------------------------ ------------------•---------------------------•-----------------•--------------------------------------- 1 -------------------•--- --------=----•---------------- ----------------------------------------------------------------------------------------------------__-__-.-•----•-----------•--- ----------------------------------- ----------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------..------------------------ ------—-------------------------------------------------------------------------------------------------------------------------------- -- --- - - -- ---------------------------------------- FINAL INSPECTIONBY:. = __ •Date - `T` - .......... ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT K j 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California k ES--9-2M Revised 1-57 F.P.CO-