9891 - Laserfiche WebLink

Home Browse Search

w APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) �� r.. _ .. . _,•�_ 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. unty'Ordinance.N0. 549. JOB ADDRESS AND LOCAT 10NJa ----------------R ---)Aho-------------------- Owner's Nam --------- -- ---------- - - --"- - --------- 'A------- Phone -------------------------- Address 4 c3 1,3 T. -------------- ------- Address--------- ----------- Contractor's Name ¢____ !_-_ o ', -------------------------- ----------------------------•------------------- -----nef -- - Ph Installation will serve: Residenc�[R..Apartment House ❑ Commercial ❑Trailer Court ❑ Motel s❑ Other ❑ y .. . . �X .r n �j j� t` I Number of living units: _ Number_of bedrooms "�Ntimb��er.fiof bah __�1_ Lot.size ----Z, __ _ -!�-0th_______ ____________ Water'Su I Public's stem Communit s stem . '' ivat.'\D e ppY� Y ❑�� Y�, Y ❑ }��ivato lY Dep#17 to Wate,r•Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandyoam - Clay Loam Clay �_No.R_dobe ❑ Hardpan ❑ V 1 Previous�Applicatio"Made:—Yes.IE -No��New--Construct-ion , Y-es» —No,[D' FHA 1 es .� TYPE-OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or`cesspool permitted if ub•c siwer is available within 200 feei,) Septic ank: Distance from neare t well '{ IQ�� y, istance from foundation_________________;Material___ ....... ... No. of com a`rtments_____________ __ ___�'-Size------...---------_--'----__-_--Liquid de th_.•______-_________-- Numli ber,of l nesearest wel 'Length e s Disposal Field: from foundation_ __Distance to nearest I1 I• e�_ [v� _-- of_each line-------_-' _-0_ ,1__.Width of trench•---___--- ---- i y 'T e of filter materi +� filfer material_______--� f--._- } Yp s ''Ppfih of Total length . ,L .. Seepage Pit: Distance to nearest-well---------------- 'Vbisfancs from foundation-------------_______.Distence'to nearest lot line_________________ ❑ Nurr3ber of'.pits ------=-------------Lining material__=----------:---------Size: Diameter---------------------._Dept h--------------.-------------- Cesspool: Distancl� f3-.orn nearest well--_______,-___-_Distance from foundation______________•____.Lining materia!___.,.------------- ----- = ------------------ ---------- El --Depth-------------------------------------------- -----Liquid Capacity-.--------------------------gals. fSize Diamefer_____________ Privy:. Distal fr m nearest well _L. _._Distance from nearest building----------------------- 0 ` "" 7DiInce ttnearest lot-line -- ----____ �----- �. , ---- --- ----- - --- - ----- -------------------------- ----------- - {R m�Qdelir� an { repa�ng (desc i �='"------------------------------------------ - ------------- -- - am"9F• - ----------•------------ --- ------------••------------------•--------------- --- - r .� ------------------ --------- ----------- ----------------- --- ---------------------------• -------------------- -------------•---•----------- I hereby certifytliat` .`ha'vepeparedthis application and that the work will be done in accordance with San Joaquin County ordinances, State laws,: and rules and: regulations of L46 San Joaquin Local Health!District. (Signed)-__,_--_ v_ _sy _ h [Owner an /or Contractor) -------------------------------------------------- A = . _ -�_ -- .------ff itle)----- --- -- --------------- ----------------------- By:__ E (Piot plan, showing size�o ot, loeatici of system iri rela#ion to wells,-buildings, etc., can be placed on reverse side). FOR DEPARTMENT .USE ONLY APPLICATION ACCEPTEDf BY., ` = -------- ------ -------- ---------'----------------------------- DATE A ------ ---------- ---------------------- REVIEWED BY-:----------- = _ I DATE' --------------------------------- BUILDING {{ f BUILDING PERMIT ISSUED --------------- --------.-- DATE- . - Alterations and/or rec mmendations:__.:----------------------------- ----------- ........ --------------•---- ------------------------. -----------------•-----•----------•----------- ------------------------------------------------------------------------------------------...-------- --------------•----•-----------------•-----------...--,_---- - ----------------------------------------------- ------------------•------- f� 1 / J _ _ C/ �iC - f,�{tit �- -�V- - Ir _. � L } FINAL INSPECTION^BY:-_"-- _r - '=--------= ------�—=-- n— .. = - 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 i ES--9---2M Revisea 1-57 F.P,CO.