10339 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. __ ._�_. .. . .. (Complete in Duplicate) Date Issued ... Application is hereby made to the San . qual Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1_14 JOB ADDRESS AND LOCATION------_____ ._ _ ____ _ _____A7� ---- ------- --------------------- ------- —_-------- ------------------------- Owner's Name--------------121_,411 - ---------------------- --•--- Phonefk- r?�.J� ----- - ------------ Address-----_--------------------------------------------------,l Contractor's Name •------------- Phone_, Q�+-74,2-- - ---------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L___ Number of bedrooms I___ Number of baths __!___ Lot size ________- `� ��''�-�-------------- Water Supply: Public system le&mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [:] Clay E] Adobe grlkarclpan ❑ Previous Application Made: Yes E] No New Construction: Yes ; No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,r 1,", f nn Septic Tank: Distance from nearest well_-__Distance from foundation_----- 44 0—� / Ll_ -------.Material----- --- - ®-� No. of compartments �_______ Size__ '' `� - p ---- iz -J- - -/---�.------Liquid depth_.__-------------Capaci Disposal Field: Distance from nearest well_)-sal?- Distance f3om foundati -Distance to nearest lot [R" Number of lines____! _ __ _ _ Length of each line_____ _0--------------------Width of french____c !!-__•-----_--_-- Type of filter materia Depth of filter material__--__Ij_r._____Total length____-____E097- --- -- --- --------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits______________________Lining material-----------------------Size: Diameter------------------------Depth-------------------------------__ Cesspool: Distance from nearest well----_------------Distance from foundation--------------------Lining material-------------------_.---------------- ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--------------•------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building - ❑ Distance to nearest lot line------ --------- -------- --------- --------- -------------•-------------------- Remode'ling and/or repairing (describe):-------- -----------------------------------------------------------------------------------------------------------------------•-----•----••---------•----•-----------•-•----•--•-----------•-_-............................... --•--------------------------------------•------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•---------•-- I hereby certify that I have prepared this application 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. r" Signe ____ ' -------------------------- t ContractorScp.acTanA4� ) ----- "��'F.:n►R�- Title) ------------- -- - ------------------------------------ (Plot plan, showing size of lot, n of system9oelEt�FiolGvells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- ----------------------------------------------- DATE------------------ REVIEWED BY---------------------------- ------------------------ -- ----, DATE---------- - - -------------------------------------------- -- -- ------------------------------------------------------------------- _4 - ------------------------------- UILDING PERMIT ISSUED___________________________________________ DATE____-_____ - -- -- --- ------------ Alterations and/or recommendations_______________________ • - --------------------------•----------- FINAL INSPECTION BY:-.--- G �^" Date SAN JOAQUIN LOCAL hIfALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California U-9-2M Revised 1.57 FP.CO.