16723 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) _ - Da+e. Issued _________ _________ _ --------------------- This Permit Expires 1 Year Froin Date Issued Application is hereby made to th-e-San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with-Count.y-Ordinance No. 549. E IVl NTE-cA E 6' 51DF SCP&oma w ,t„ �� ,,/ �j JOB ADDRESS AND LOCATIO44100IIW 'I _ =_._ ...._� �E-------�___47 ----____i_ _l l-�-�l------.1 �------------ na Owner's Name-�---- r ? �:-[-�........ �_dC --------------------------------------- Phone------------------------------------ Address------------- -----------------------•------••-•-Address_____________ ___ __ -----•-- ={ �,7• �f1�----- _l _l'_hr--------------- Contractor's -----------Contractor's Namem�C a.,__5zpv -___511—�PKV-1-c°---------------------------•--- ------'•-------------------- Phone----------------------------------- Installation will serve: Residence VApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numbe'r'of living units: __1____ Number of bedrooms ___.Number of baths _'L Lot size __/-1p _x__-4 _________-_______ Water Supply: Public system ❑ Community s tem ❑ Private Depth to Water Table _,?-_ ft. £ Character of soil to a depth of 3 feet: r Sand Gravel ❑ Sandy Loam ❑- Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes date__ --;"" ] No,I�NewConstruction: Y°�� o FHA/VA: Yes)ff/ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted' if public sewer is available within 200 feet.) Septic Tank-. Distance from nearest'well; __�©__-__Distanc from foundation---1�________.Maten I____4 1.C_R-r ~_- -�`, tr - lD k $7_Li uid de th_---_ Ca acit J�<_�-_ No. of compartments Size q P. ------- P Y b� Disposal field: Distance from nearest#well __5-�__--___--_.Distance from foundation----/ Distance to nearest lot ----- _ � li-n--e---_-----�- -------- Number of lines--- _--- A----------------Length of each line----P-fi- -A 0------Width of trench------- Type ------YP olematerial: �G Depth of flter material____ � ..........Total length ------------- j i �0Seepage Pit: Distance to well rnG _____-_ ____'Distance from foundation____________________Distance to nearest lot1ine______-_______-_ ElNumber of pits-----------LI-__-Lining material---------- ------------Size:Aiampfer-----------------------Depth +I-f Cesspool: Distance from nearest well_________________Distance from"Toundation__L 'Linin material_________-____-__-�- _________- W - ---------- 1 . Size: Diameter------ ------- - ------- ----De th- ❑ P Liquid'yCapacitY "- gals. 1 Privy: Distance from nearest wel� I _ _____________________________Distance from nearest building_____________ __,"-_.__-_____-___- ❑ Distance to nearest lot line- - .. - ----------------- , i . Rernodelin and/or repairing-(describe): describe :-___= �f.-1-:- 1�_ �---- -----------------T- - ---- � -1h1 _ -_-_.-�---�: ---------------------- ------------------------ ------------------------------ -- --- ----- t ---- --------------------------------------- --------------------------- --------- -------------------------- --------------------------------------- --I----------------------------------------------------- 00 I ------ ----------------------------- I hereby certify that I have prepared this application and,,thaf la -fhe-work,;ill be done#in accordance with Sa'n Joaquin County 7 ordinances, Sta#e ws, and rules..and regulations of the San"Joaquiri,LocaI`Health Dis4ricf. (Signed)------ ---- ! J ="�"' `� ---------------------------(owner,and/or Contractor) - ---` - --=----- .-� (Plot plan, showing size of to, ocation of system.in relation to wells, buil Ings, etc 'c nbe placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY _pL•D ` DATE----- �p� ,� .�- 3--------------- - REVIEWEDBY--------------------------------- --------------------------------------------------------------*1----------------------- DATE-------- ---------- BUILDING-PERMIT-•ISSUED.-' --------- --- . ._ - — :DATE-4_�_---== - - - -------------------------------------- -------- Altera+ions and/or recommendations-------- ---------------------------=-------------------------------------------------------------------------------------------------------------------------- ---------=------------------------------ ----------------------------------- -- --------------- ••----------- - ------------ V I� t4 �1 ------------------•-------------- ------ ----------- --- ------------------ -- - . a _ i FINAL INSPECT ---- W_ , Date_ Jje. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California -Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.PMCL