9407 - Laserfiche WebLink

Home Browse Search

��►`�( APPLICATION FOR SANITATION PERMIT Permit No. ._:a_ (Complete in Duplicate) f x S (/t Date Issued ..... Applicationi is'he?-eby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatioii�h made in complianee,with County Ordinance No. 549., 6 JOB ADDRESS D CAT N••-- --_ ----- - ------- " ----- -------.............--...................... - - ------------ ...ZY Owner's Name--- ---------► `._ - Phone Address-----•------5.�.- -••. s==- �: `"' . ------------ ----------------------------------••............•-••------- -•••.-•-••••••••. ••... Contractor's Name -t --- ------------------------------------- -----------•----- ------------------------------ Phone. Installation will serve: Residence [ Ap grtment House ❑ Commercial'o Tra� Court'rf Mot l,© Othert❑ Number of living units: J.. Number of bedrooms . _ Number of baths L/9. /Lot size _ ,: ---•------- ---------------------•- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sond Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe ardpan El Previous Application Made: Yes E] No New Constkuction: Yes ;No ❑ FHA/VA: Ye ❑ No TYPE OF INSTALLATION AND-SPECIFI�ATIONS: (No septic tank or'cesspool permitted ' ublic s er is available within 200 feet Septic,Tank: Distance from nearest wellE�c^l' Distance from foundation!_ �° -.Mat real- =xt-4-:. No. of compartments_:____. :_ _ ._fl Size --------------------__.•Liquid gept"h---- -__Capacity_ A'_ f' • Dispos Field: Distance from nearestlwg1I #___. istance from foundation" ________. istance ; e rest,lot I e L ** Number of lines-_ ___r Length of each line......... Width of ._ at_ . ... ....... _ Type of filter materia f nepth of filter material.- Type Total lengt ___...------- --- ____ _._ # -, !t r tans o nearest I►ne__...._. S epag rt: Distance to nearest w II_ ` ___w___t____Distanc from foundation+ �9 l� Numb,of pits_._____.. ___Lining material. i< _ '::Size. Diamete 7�,�_ a. pth . C s ool: Distance from nearest well_________________Distance from foundation------------. Lini a al`_ ...____ Size: Diameter--------------------------------------Depth--- -------------- ; ----------------Liquid Cap city ------------------....gals. Prr�; Distance from nearest well ________ _______-___ __---_ -_-.____-_-Distan�e from nearest buildin :.-_:___------.-...............-,....._. Distance to nearest lot line----------------------------------------------- ------------------------------------------------- --------------•----- ----- . ----------............. ......... `1! Remodeling and ... /or repairing (describe):----- -----•- -- -------- ------- ---- - - ......•. ..--••--. -------------------•-----•---•--------------------•---------------•-----------------------•------------------•------------------•------+ --------------------------------------i ------•-----• •-•••••••• . •- ---- ----- --- ---------•--- -------- --------•--- ------- I ---I hereby certify that I have prepared this application pnd that +hc work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations. of the San 3oaquin Local Health District. (Signed)----------- -- ------ -----------•---------------------------------------(Owner and/or Contractor) By:----------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------•---•--------••-- (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 APPLICATION ACCEPTED B DATE..r . "`" -•--------------- ------------------------ REVIEWEDBY--------------- - -- ------------- -- ---- ------------------------------------------ DATE--- .................................................. a BUILDING PERMIT . + re+'oISSUED---•• -•- k ti - ..}. ;. _ ---_--------------- D A TE---.-•-- 4 . ..._..... ns and/or recommen atiomr - ----. ---� _- ....__. ----------_-----_---- -..---- - __- .._ ---- __ ..... -----------------------------------------------------•-------•----------------------------------•-----•-----•----------------------------•------..----.--•--..--------•-----......---.•------••---• . .......-•••---•_. ---------------------------------•--------------------- --------- - ------------------ .....•-- ................. _ �-5 FINAL INSPECTION BY--------- ----- - • -------------------------- -........ Date.(5 . 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-9-2M Revisea 1.57 F,P.CO.