13234 - Laserfiche WebLink

Home Browse Search

FOR OFFICE/ SE: ` �� -----------_------ __ _ _ _____ APPLICATION FOR SANITATION PERMIT Permit No. 1.... - ... 7 ---- --- -------- - (Complete in Duplicate) V� Date Issued --- ----- -------------------- -- - --- This Permit Expires 1 Year From 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 Counter Ordina No. 549. JOB ADDRESS AND LOCATION - ----- -------- $ ------------------------------------------------- ---------- W__�_ Owner's Name ---------------------- ----•-- ---x_- Phone—....................------------ Address---- -----...._.Address---- - Contractor's Name----------,`/-E------ ----- -- ------ ----- •--------------------------------------------- --------- ------------------------------------------ ------ Phone................------------------ Installation will serve: Residence Apartment House Commercial ❑ Trai r Court ❑ Motel ❑ Othe� 4 r Number of living units: N ber.of'bedrooms .._� Number of baths_ Lot size / _... ------------------ Water Supply: ..Public system CommunitL. y system ❑ Private ❑ Depth to Water Table '� ft Character of soil-to a deptli�of 3 feet: Sand ❑ Gravel E] Sandy Loam Clay Loam ❑ Clay`❑I Adobe erdpan ❑ Previous Application Made: llf'yes,'-date______________ 1 No ❑ [�� /VA::Yes ❑ No j } � - New Construction: Yes No FFfA � i TYPE OF INSTALLATION AND\SPECIFICATIONS: , ..W "r (No se tic tank or ermined 'if f biic sewer is ailable within 200 feet.) ( P P PW cess ool ^� Se tiC Tank: Distance fro ii nearest well-_z------------Aistance ff om.foundation__________ `„�.M genal:_-__ ____ � _ .. W % r No. of compartments___ ___________------ Size ___ :_—_�_____--Liquid depth__.__ pacit __.e _._s Disp�al F�dld: Distance from nearest welL___�_____________Distgance from foundation--------------------Distance-�to nearest ld+ line._______.___..___ Number of lines_____________----'`_---_______Length of each line-----------------------._-".,Width of trench--_.___f___t.--------------------- Type :___________-__ YP _ Y P . , g� ------------------ ' See a- a P'+: Distance to nea�esf well____________ __,___Distance:f. m foundation--AP......_.. D•stance oto. nearest lot Ime_� T e of filter rdaterial_________________________De Depth of filter material_.--.____________._'__Total len th___._ __ _.___: ____ Number of pits-;---/ s ----------•--Lining' natsrial- _--.size: Diameter-- - - �----------1';De th- ---T•-- Cesspool: Distance from nearest well------------ -__-Distance from founda tion---------------------Lining materiae_.______-`r_.-_____---_-_. ❑ Size: Diameter--- --------------- ----------Depth---------------- ' ?_Li uid Ca aci Privy: Distance from nearest well~___ _- ::.°`----------- -"'------------Distance from nearest buildin �_-_- ❑ '<_ ,.- Distance to nearest lot line ------ -- -------- Y ----•--------- •--------------------------- y M � 1� Remodeling and/or repairing (describe" -g�r� = -... = -----•---•---------------------- � i ..,=- ` s ----- -------•-- ----------------------- -------------- ------- i r ! herebycertif that I have prepared this application and, •-�---------------- --------------------� ---- ---�-�--------•----------------------'------------------ Y P P PP that.:}'e work will be done in accordance with San Joagpin'County ordinances, State laws,{and r les and regulations of the San Joaquin-Local Health District.. (Signed]-------- --Y - rContractor) 3 (� Plot plan, showing size of lot, location of system in ation to wells, buildin s efc �can�be ]1 4 �� iv�. By:-" --• ------ --- --• Title_:___ ( P 9 y g , p aced on reverse side]., FOR DEPARTMENT;USE ONLY _..__.- 77w,., APPLICATION ACCEPTED BY- ----------- -------I----------------------------------- DATE-- l REVIEWEDBY------- ----------------------- •--------------•----------•--- DATE---•..- BUILDING PERMIT ISSUED-----------------------------------------------.--------------•--------------- ------------- ...... DATE Alterations and/or recommend ations------------------•-=_-------'---------------:------------------------------------ ------------------ ----------------- --------- - - -- --- } FINAL INSPECTION BY:: Date------------C ----------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT J�1 r!, 205 West 9th street 13 South American Street 300 West Oak Street::' 124 Syioaae Stockton,Colifornla Lodi,'Californiar Manteca,California Tracy,California rs•9 REVISED 8-59 r.P.00.2M 6.6e I.