10907 - Laserfiche WebLink

Home Browse Search

ly �ox- APPLICATION FOR SANITATION PERMIT Permit No. { (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is.made incompliance:with County Ordinance No. 549. JOB ADDRESS AND LOC--A T-IO_ N_-----�- �--- -�-`- - Owner's Name--------'--- 7 ------ _ ------------- ------------- -------------------- ------- ---1--4--r-j----------P-rhone---------------------------------------------------- --- Address e __�//,/--•--------1-1•------------------------ - Contrac+or's Name --4------_--- Phone/ X_V_ " Installation will serve: ResidenceApartment House E] Commercial E] Trailer Court E] Motel ElOther ElNumber of living un- .tumber of bedrooms , Number of baths _-/__ Lot size ___ --------- ---------------- Water' Supply: Public syst Community system ❑ Private ❑ Depth to Water TableQft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑'- Sandy Loam Clay Loan' ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ NoA New Construction: Yes ❑ N01�( FHA/VA: Yes ❑ No i TYPE OF INSTALLATION AND SPECIFICATIONS: ) (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) / ptic nh Distance from nearest well- -----___ ___ _Distance from foundation Liquid de 'th Material---------_Ca acit �* No. of compartmentsSize_________________ lr. �( p ��jjq P. p Y Dis os I Field: Distance from nearest well_1 .______.._.Distance from foundation r ` e _ R - �t'�________Distance to nearest I�line,� { Number of lines________________________________ Length of each line________ /` Width of french.__�_f _* ---1---_- Type of filter material------RO_C, C�Depth of filter material____ ''._____Total length---------- --- ----________-- Seepag Distance to nearest w/ell-_--h* '1�---------Distance from foundation___��-_ __----Disttance"to to lest lot Number of pits--------- ________-Lining material-_ OC e—Size: Diameter____._:- _ Depth---Vie_________________ esspool: Distance from nearest well----------------- from foundation____________1------Lining material-----.____________._________-_____. ❑ Size: Diameter------------------------- ------Depth-----------------------------__--- -----------s----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-------_-__---______________________- ❑ Distance to nearest lot line----------------------------------------------—--------------------- Remodeling and/or repairing (describe):------ _-------- --------- ------------------ ________ ----- ---------- rte'---- � r - - - ---------------------------- ---------- = = .�-� ------------------------------------------------------------------------------------------------------- I hereby certify that 1-�ha prepared this Zppl,ication and that the work will be done in accordance with San Joaquin County C ordinances, State laws, and rules and rI do is of San Joaquin Local Health District. ,ATjf .� { Owner and (Signed)------------------------------- r Z� ---------- ------- /or Contractor I �� (Tit ---_ .. r _r (Plot plan, showing size of lot, location of sysfe' in relafi n to welllss,,441dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. --------- --------------------------------------------------------------------- DATE----:-J - -_ J� REVIEWED BY------------------------------------------ - - ----------------------------------------------------------------• DATE---------------' -- --------- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- ---------------------------------------------------- Alterations and/or recommendations: ---- ----------- ---- - ----------•-----------------------------------------------------------•------------------------------------------------- y------- - � ) - - m ----T==-==-- --------------------------------------------------- -------------------------------------------------------------------- -------------- FINAL INSPECTION BY------------- - - --------- ------------------•I---- Date----11.1W- ---------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Sfree+ $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--4---2M 12evisea 1-57 F.P.CO.