11697 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. --�,�� -• --• r� (Complete in Duplicate) Date Issued --- �' This Permit Expires 1 Year From Date Issued A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. PP erey This application is..made in3co `ra mpliance withiCountyOrdinance,No:'.549. ,..�•.. � � "t�'�w JOB ADDRESS AND LOCATION_,— � ` ,' Phone U,. _.7� Owner s'Narine ��a��---�-- ----------------- Address----------- -------.Cl. ----- ------------------------------------- ------- -- Phone. Contractor's Name----- ---- Installation will serve: I Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living rir�.inis: :_ _- Number-of bedrooms=: .__:.,.N umber-.of batfis,�\Lot,size_________________ _-.----••------------------------- Water Supply: Publicjs stem Communit s stemPrivate ❑ Depth fo Water Table -- ft. PP Y= � Y ..�'. y y ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 4 Previous Application Made. Yes ❑ No [E,'*�New Construction: Yes eNo ❑ FHA/VA: Yes ❑ N€ fr, s TYPE OF INSTALLATION AND SPECIFICATIONS: � $ (No septic,.tanksor cesspool permitted if public sewer is available within 200 feet.), ! ' �� Materia4 f --------------- - Tank: Distance from nearest well_'�'l Distance fro foundation- __ 21 �',.No. of compartments-------j-------- .Sizer-x4!' _X--I------Liquid depth---- -Yrs r Capa#itY - "�` . r +?r Disposal Field: Distance from nearest we4l-214_wrLt_Distance from foundation---I4---------- Distance to nearest lot line l- ------- Number of lines------------ -� _-_-- Length of each line--------.-.�_ ---------.Width of trench-----. - ------------------- 4, 1 Depth of filter material_____140_�------Total length of filter material____ _ _ ___ p •� 1 Seepage Pit, 4 Distance to nearest well_____.--___----------Distance from foundation___________________.Distance to nearest lot line______________-_ ❑ Number of pit,j-- ,w ltirsing material - ..Size: Diameter---------�4---�---Depth---- - -------------------------- ► f Distance from nearest 11 --gals. from fodndation-------- material._ Cesspool: Li uiCa acit -------------------------- -- i________________ gals. ❑ Sze: Diameter--:_.--------! --- -------Depth-- ----------------------- q P Y----�-------------------- gip o+�_,-..___-__.__--__Distance from nearest Iaf i4ding Privy: t,7Disfance from nearest well..__ ____� _„q � *'- `9 --------------------•----------------•----`-------- Qiei a�ncet ynearest lot line-------r• - ----- � l -�----------------••-----•------- Remodelintg and/or repairing (describe):___-___- 'l %t -- -- ---- � ;: _ '- - --- w_ i ---.._.__,_z-- _ --------- - `'' � °: +r' "* '-------------- -----� ----- ---- �. ea I hereby certify tliat I ave prepared this�applicatii 9 n ,hat"the work will be done in accordance with n.=Joaquin County ordinances, State laws, and rules and�}e�gulations of ¢he yn,wo quin LocalrHeaith Qistrict. ..Owner `and or Contractor '= -- - i Si ned _'�' '- - a- ---- ---------- -_A c / { g } , I ) By:r: �--- a t e ----- { (Plot plan,showin"g,size�rf, lot oc n of system in rela4i-n to wee , bw lings, etc., can be placed on reverse gide]. �D};PARTMENT USE ONI: '� FO1Y; .�- + APPLICATION ACCEPTED BY_. �___.-- 'u/k; DATE 0------------------------- REVIEWEDBY------ f--------- -- I - l _ DATE------------------------------------------ BUILDING PERMIT ISSUED--- ------ ----- ------------------ -- DATE--------------------------I--------------------------------- . Alteration and/ar recommendationzt: f ;---- ------�-- ;�- __--- s;. F ------------------- ' ---------_�- ------------------f-------------------------------------------------------------------------- ----' -==` ' ------- ------------ -- = ---------------------�w------ _---------- a -------- -------------= :_: _ - _____________ - r ---------------- ------------- .______.___...___.___ ----------------------_------_------------------- FINAL INSPECTION BY:___- ..,__C..-'. •� ^I------ Date / •------ -------------------- ---- . SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+ Oak Street 132 Sycamore Street 914 !`forth "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California Y ES-92M Revised 8-'59 F.P.Co.