9236 - Laserfiche WebLink

Home Browse Search

r ?� APPLICATION FOR SANITATION PERMIT Permit No. .- -• -3-•-- 1n Duplicate) ` (Complete p ) Date Issued _____ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance"with County Ordina ce.No. 549. ' a -3 6- Ja rro» { JOB ADDRESS AND"LOCATION-- 4 ''I_ f � ` °` ,3/•°------ Owner's Name-_-Ar-------------- i��= 7�r+44-•------=--------- - =------------------------- Address ------------- -_. Phone__._.. --------- - ---- Address---- 'rx' --'-4? _3!111 1 -_--- ---------------------------------------- --------------•--------------------•=--------------- ••------- Contractor's Name_ :. - s y-.cr----------------------- - ••-------- Phone-- � 6 � Installation will serve: Residence [ Apartment House ❑ Commercial ❑- Trailer Court [:1 Motel ❑ Other ❑ t Number of living units: J__='_ Number of bedrooms -._. Number of baths _l.___-_ Lot sizeJhr---1 --------------------------------- Water Supply: _Publi system "❑-Comm u6ity`system" E] Private';4 "Depth to'Water-able dD Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandi Loam ❑ Clay Loam ❑, Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ NoK New Construction: Yes ] No ❑ F,HA/VA: Yes.❑ No ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Y f Septic Tank: Distance from nearest well__. --------Distance from fon ation-_/�__--_-__- _.Material------------------------------------------------ No. of compartments-- -----------------Size-, . _��-- ---Liquid depth_-3!!�---.------_S-Capacity--r�. ..... . Disposal Field: Distance from nearest well-R_0-------_Distance from foundation__Z4d- ----------Distance to nearest lot line__'- Number of lines----/---------- ------- tLength of each line--------g-Q---------------Width of trenc ..-�--f/��------ - - -- Type of filter iliate�ial° � 1-----=Depth of filter material____-- _"_ Total fen th_i_ -_ _-._: g Seepage Pit: Distance to nearest well_'��,- "---_Distance fro foundation_:. P:____-..:.Distance to nearest lot line__..________ �] Number of pits°__�-'-'-�:"-i::-._.Lining material - Diameters? .--_--Depth . ______.t__.._...__ Cesspool: Distance from nearest well----------------- Distance from foundation-------------------,Lining material__"____-___-----.,. ______.__. � ❑ Size: Diameter-----=- -------------- ---------------Depth----------------------------------------------`-----Liquid Capacity:---------------------- ..gals. Privy: Distance from nearest well------------ - ----------------------------------Distance from nearest building_;_ ----_--_-_ _-_---. V Qistance to nearest lot"I rye --- --� .'�:'--- ------- •-------- ----- ry - r Remodeling and/or repairing "[describe):__ ---- ---- --.--------------- -------------------------------- f f � ---------I, -------- •---- -------------- ------------- .. - i- - -3--- . hereby certify that I have prepared this applica+ion and that the work will be done�in"accordance with Sin-Joaquin•-Goun+y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.' S� ned _ _ 41 --------"------------------------------------a= - (Owner and/or Contractor) { 9 } V y " [Z ------------------------------------------------- {Ti+le) (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 BY__"_ ------------- REVIEWEDBY------- =-------------- M •-------- DATE-------------------- =----------------- BUILDINGPERMIT ISSUED-----------------------------------=----------`----------------------------------------- ----------- DATE--------------------------------------=---------------------- Alterationsand/or.recommendations:-•------=---------------------------------------------=-•----------------•-----••-------------------•-•------------------------------------------------ ------------------------------------- -------------------------------------------------- ---------------------•--- ---------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ ---------- ---------------------------------------•------------ ------------ ---------------------------------------------------------••--------------------------------------------------------- --.--•------- R r ------------------------' ---1-- ------- ----------- ---_-._---------------- -: ---------------_----'----------------------------------- Date ---,-------_--------- .. FINAL INSPECTION BY:.- == __ �p % ' Date - 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 ,- Revised 1.57 F"p'Co.