11164 - Laserfiche WebLink

Home Browse Search

3 �t 4 APPLICATION FOR SANITATION PERMIT Permit No. i �1 (Complete in Duplicate) � � � •,. pate Issued ------- _1D 7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the or rei &scribed. his application is made in compliance with ounty Ordinance No. 549. frr JOB ADDR1rr'55 PtiND'LOCA ION---- ----- -- _PF.- -- --- - --�- --fes.----- -- I---. --- b ----- --------- - �� wner's Name--- ------- ----- - ------------------- Phone------------------------------------ III ddress X �� Contractor's Name----- z'" ----------------------------------- - -- - ----------------------------- Phone Installation will serve. Residence [B---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/--- Number of bedrooms Number of baths f=;Lot size _Z-4 , __________------------------------ Water Supply: Public system E] Community system [IPrivate--Rj�epth to Water Table3X it. 1111 Pr of soil to a depth of 3 feet: Sand E] Gravel El "Sandy Loam [Clay Loam ❑ Clay E] Adobe F] Hardpan Previous Application Made: Yes E] No R-�New Construction: Yes g?—Iqo E] FHA/VA: Yes [ IJ Tb El TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Lpt c an Distance from nearest well—J -----Distance from foundation----1Q---------Mate if__-._ _ r _ ._________. No. of compartments--- - -- -----------Size--- --- -- - ------- / - - ` - -Liquid depth--- _x Capacity__-- _ - -- -- isposal Field: Distance from nearest well----(G_� -Distannce from foundations_ _____ stance to.nearest lot line____47____ I I ®� Number'of lines---- -_l/_ --j�^---_----_�-----�cjj60"gil-of each line--------7�� WicK of tranch_---�.-jv-� -- --------_ � Type of filter material_J ��Ga/{.Depth of filter material___.1 ��____-Total length-_________ - _�-!�1__�- eepage Pit: Distance to nearest well__/eop._�Distance from'foundation : _____ �i ,4.___.Distance to nearest lot line_��_�__�� [fes Number of pits------,�___.,,,_Lining-material---/.eP& Size: Diameter____ __ ____________Depth_-___ ___ -------------- Cesspool• Distance from nearest well_________________Distance from foundation'------------__.Lining material-------------------------------------- I~ --- --- -------De th--------------------- -----------------------------Li Liquid Capacity als.� Size: Diameter---------------------- � Privy: Distance from nearest well--------------'----------------------------------Distance from nearest building--------------------------------------1 I � ElDistance to nearest lot line-----------------------r--------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- � '��-------•-------------------------------------------------------- -----------------------------•----------------------------------------------------------------------------------------------------- ------•-----------------------------------------------•----------------------------- --------------------------- ---------- ------------------------------------------------------- �! --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- -- - - uI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �irdinances, State laws, and rules and regulations of the San Joaquin Local Health District. Signed) -_ r Contractor ---------- -- --- II� -- --- ------- - - Y: � ---------------------------------(Title ��' i (Plot plan, showing size of lot, location of s m in .relation to wells, buildings, etc., can be placed on reverse side). i11t FOR DEPARTMENT USE ONLY IIXPPLICATION ACCEPTED BY----------------------- DATE---------------- � T IiREVIEWED BY-------------------------------------------------- DATE EUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE------------------------------------ ---------------------- ilAiterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------•----------- ii!. 'III ----• --- ----------------------------------------- =---------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------- IIi FINAL INSPECTION BY--- - --- -- -- -- - - --• ---------- - ------------ Date---- -,02-/-T --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i I Stockton, California Lodi, California Manteca, California Tracy, California i i ES-9-21A Revisea 5.57 F.P,CO. . r