8964 - Laserfiche WebLink

Home Browse Search

M 90; APPLICATION FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) 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 Ordinance No. 549 JOB ADDRESS AND �Q��CAI N___5 --- ------- ------ --------------------------------------------_------------ _ ----------- Owner' ---------- Owner's Name---- ---- -- Phone.' -_---------- --- ---------------- -------- ---- ---------:------------- -- --------------Jf--------------------------- ------------------------------------------------Address----------- ... . ... ---------------- ------------- Contractor's Name------—0 _,ce: ------------ Phone-------1......---------------- Installation will serve: Residence &---Apartment House F1 Commercial ❑ Trailer Court E] Motel E] Other E] Number of living units; gx?--- Number of bedrooms 9--- Number of baths Lot size ----------------- Water Supply: Public system ��Communify system F-1 Private E] Depth to Wafer Table fi�;-,ff. Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam E] Clay Loam E] Clay [] Adobe&O'Hardpan El Previous Application Made: Yes E] No �New Construction: Yes 0 No EEr__FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permiff ed if public sewer is available within 200 feet.) Seia,fic.Tao- Distance from nearest well-----------------Distance from foundation-------------------Material--.___--.__-__--__---.-------...._......_._._..-. W1F 1 No.�of compartments--------------------------Size--------------------------------.Liquid depth--------------------------Capacity------ ----------- Dis sal ' d:' d: Distance from nearest well--------------- -Distance from foundation--------------------Distance to nearest lot line....-..._-.-...._ J . I Number of lines-----------------------------------Length of each line-----------------------------Width of&AAtrench----------------------------------- 12 Type of filter material------------------------- ri-) 1 Depth of filter material___..______._____...Total--- --------------Total length------------------------------------- '. - Distance from fo6 afion-_ s ance to nearest lot line----0:�'_ Seepage Distance to nearest - ---------- D' t -------- ------ Number of pits---- -----------/--------------Lining materia -.Size: Marriefer- ------ K ;Mac fou D,pfh___0;'VA ------------ Cesspool: Distance'from nearest well-----------------Distance from foundation----------------------Lining material.......---_-..--,---.------__--_---- ------------------------- El Size: Diameter--------------------------- ----------Depth----------------'--------------- ------------------Liquid Capacity-----------------------•----gals. Q Privy, • Distance from nearest well------------------------- .-------------Distance from nearest building----.------------------------------------. El to-Distance nearest lot line--------------------------- ---------------------------------------------------------- 0--------------I--- ----------------------- Remodeling and/or repairing (describe):----------------- ---------------------------------------------- ------- ---------------------------------------------------------------------------------------------------------------------- —-------------------------1---------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 uIes and regulations of the San Joaquin Local Health District. I 'eT T T San "r '3 (Signed)------- .... ... -L----- --------- ---- -- --- ---------- --------------------- ---------------------(Giw��Confracfor) m Joaquin C Contr - ---------------- ourt, acfor)j By:----------- ------ ----------------------- ---------------------------(Title)--- ----------- ............. -- ----- i t. I f (Plot plan. showing size of, location of system in relation to wells, buildings, etc., can be placed on reverse 6?ej.44 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- ---- ------------------------------------------------------------- DATE--- - ----- _�I ----------------------------------------------- REVIEWED BY------------------------------------ ---- DATE-- -------/------------------------------------- --------- ------- ----------------------------------------------------------------- BUILDING PERMIT ISSUED------------ --------- -- ------------------------------------------------------- DATE--------- ---------6-- ------------------ ---------- s Alterations and/or recommen ations:------------------ -----------------------------1---------1-----------------.777-%-------------------- -- -------- ---------- ------------- ---------------------- ------- ------------ - ----- --- I f----- ----- ------------- -------- ...... -- - - -- I -Z - - C -- --------------------------------------------------- ----------------------"--- ------------- -------------------- ------ ---- -- ----------------- ----- - ---- -------- ... ------ .. -------- ------------------------------- ------------------------ ---- ------------------------------------- -- ----------I------- - ----- ----------------- - - - - -- - --------- ------------------- -- ----------------------------------------------------------------------------------------------- FINAL INSPECTION BY-------------------------------- ---- --- - ------------------- 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 Rovisoci 1-57 F.P,CO.