15740 - Laserfiche WebLink

Home Browse Search

'09WkOFFICE USE: « t. ------- ---- ........................ ... APPLICATION FOR SANITATION PERMIT Permit No. . S . .. - (Complete in Du hcate ( P P ) Date Issued .: J.� ---------------------- This Permit Expires 1 Year From Date Issued J� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thew herein described. x, This application is made in complian a with County Ordinance No. 549. /11g N` C , �J_. d-I fit. JOB ADDRESS AND LOCATIO .Si.D�... R�_©N.�_.......f pLAC�......v V....aF---...V..��.U!�..---•--•----• �.' Owner's Name............ .M ....--- Phone._ .. Address 1-Z--�---•--.MAJ.. i�. -----------•- ----------------------------• ---• •-•-• Contractor's Na ........-- _. ---------------- --------------------------------------------- Phone. -•---........................ Installation II se artment Hous, Commercial Trai a Court 0 Motel Other I u or qLjjying units: j....�Number of bedrooms .._ _.. Number baths .y t size ... ............ Water Su ( rnuaify system ivate Depth r Wa r Table _ _ ft. „�µ Cha r soil to a is t dy Loam ❑ Clay am ❑ Clay ❑ Adobe Hardpan Previous ' ation Made: If es,date__ _____________ (�'� � ❑ o No • ( y -- New Construction: s o FHA/v s ❑ TYPE OF INST TION AND SPECIFICATIONS: (No sept' or cesspool permitted if public sewer is available w' feet • Septic Tank: Di nce from nearest well Distance from lour f ation ........ _..._Material.............................................. t No. compartments..........................Size......................"`-"""mid d t ity; /eepa Field: Distan from nearest well_________________Distance from foundation.�r........... ..Distance to nearest t'line �� . N& Numbe of lines......_...A____________________length ...._....4a.... Width of trench.. . 4PD ' Type of Iter material.-. LI_G ____Depth f filter m erial_... _- i� . .. .......-- Pit: Distance nearest well-__________ _______Distan f dation.._._._....._. .._.Dist a to nearest line.............. Number o pits...................... g material--------------_------Size: Diamete ................. .,Depth.... .......................... It Cesspool: Distance from nearest well. .........Distance from foundation______________ ____Lining mater) � Y -*- ❑ Size: Diameter---------------------- .......Depth-------------------------------------------•-- ...Liquid Capacity _ .gals. trivy: Distance from nearest well____ -------------------------------------------- Distance from crest building ❑ Distance to nearest lot line--- --------------------------------------------•---------------------.-. .-------•-•--•-----.......................... Remodeling and/or repairing (de"scfibe):------------- ---------------------a----------------•-•--------------------------•---•---- .. . •----•--•----•--•---•-••-•-----•-•-----•.....................••---•. -------------------•----------------------------------------------...........••-------•- .. Thereby certify that I have prepared this lication 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. s t (Signed)..... ........................ _.......(Overt and/or.'Contrector) By ... .-... --•---••-•------- ..---.(Tiflo)----------------• .4 ...................... (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc., can be placed on reverse side) FOR DEPARTMENT USE ONLY w APPLICATION ACCEPTED BY------TI• `P-'----•--------•--------•-----••---•-------------------------------- DATE_- .3.. REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE. ....----•--. • ................. ............ BUILDING PERMIT ISSUED................ ------..,.. . DATE, •----- .................................................• -•--•--• ...••--.. ......._. .--•--•. -•-.---- -........................77.3....................................... .......................... --•.............••--•---•-•--••--•--••-------•---•--•---.....----•--••-----.....--••-- •----•• .,_..................... . ........ ........ • ---- . .-- -••--•--•-------------------------------•.. _..... •---.----- ..................................••--• .......... ..----- - ----- ----._ --. --- . ....••••-----------••--••••----••-..._.....-•-•- --•--•......---••----... ..s' ._.......................-......... FINAL INSPECT .. - - - - ---- - --------- • ---- ---•--- Date............- -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT: 130 South American Street 300 West Oak Street 144 Sycamore Sttief 405 West 9th.Street Stockton,California Locil,Collfornillo., Manteca,California Tracy,California ES 9 REVISED 8-89 2M 5-62 ATLAS "+