11196 - Laserfiche WebLink

Home Browse Search

6 APPLICATION FOR SANITATION PERMIT Permit No. __11 1. 4_ KY (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 wifli-County Ordina6ce•No7549.-"" j - --- _ C JOB ADDRESS AND LOCATION... � �--- ��-�'�------ -----�-------- -•----------------------------- Z , -�-��----------- ----------------------- Owner's Name-------- L ' Vim_ f__ ��_ 2 Phone-/ Address---------------•-------==---••-----------••-•---------------- - - -- -- ------ ---- --�-�---------0 A -------4� Contractor's Name----# ------------------------------ -- -------------------------------------- Phone----------------------------------- Installation ho`e--------•-------------------------- Installation will server Residence I& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ ' I - � � 00.14; Number of living units: --- Number of bedrooms__ Number of baths ____t� Lot size ____ ______________ Water Supply: Public system ❑ Community system ❑ Private,] Depth to Water. Table ___s _ ft. i Character of soil to alE] ElE] Cldepth of 3 feet: Sand Gravel Sandy Loam ay Loam [j Clay F]- Adobe[k' Hardpan i ❑ Previous Application Made: Yes ❑ No� New Construction: Yes j9— NoM FHA/VA: Yes ❑ No; TYPE--O.F.INSTALLATION AND SPECIFICATIONS: ~`- septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well 6---------Distanc ----____Distance from foundation___/©------- .Material----- "_�_____________________ __ --- " No. of compartment-s---------;_L_--------------Size----3_X_4_--.Liquid depth------.f/-----------I-Capacity----------------------• Disposal Field: Distance from nearest well_ __.Distance from foundation___ _ '__.-Distance to nearest lot line_____ .� y zr Number of lines-------------- ----- --- --Length of each line-----------__--� .__r+.Width of trench---------- --------_-- Type of filter materiali_��' -Depth of filter material_________� Total length_`____________________ _.____ Seepage Pit: Distance to nearest well--------_-------------Distance from foundation_________ -____ .Distance to nearest loft line----------------- �\ ❑ Number of pits----------------------Lining material_-------_--------_---_-Size: Diameter-----------------------Depth--------------------------------- r�' Cesspool: Distance from nearest well________________Distance from foundation..------- ___.-----Lining material__________------------------------- E ize: ________________________❑ Site: Diameter-------------------------------------Depth------- -------------------------------J---------Liquid Capacity - ------------------------gals. �U Privy: Distance from nearest well---------------- _______________________________Distance from nearest building_,-__-------_.______-___-____.______-.- ❑ Distance to nearest lot line-------------------------------------------------------------------- - --------------------------------------------------------- ------- I Remodeling and or repainn (describe):______.I__------- ---- -----------•-------------------------------------> ------------------- - ... C�( - ----•-------{----- - ----------------- ------------------------------------------------- I ` I • `` - ------------ ----------------------- -------- ------------------------------------ I hereby certify that I have prepared this application and that the work will be doneiin accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District,-,. R_ _ -------- T- «...,.�".----(Owner and/or Contractor) (Signed) -- -------- Title) (Plot plan, showing size of lot, location of sys a in relation to wells, buildings, etc., can be placed on reverse side). r-r-FORYDEPARTMENT USE ONLY -- ,, f� APPLICATION ACCEPTED BY------------------------ ----- -- ---•- - DATE _-- .- - REVIEWED BY i - i �, ------------- --------------------------------- DATE------ -----------i PERMITISSUED--------------------�; .------------------•--- � )------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------- ------------------ -- ------------ ---•---------------------------------- ----------------------- ------------ -------------- - — ,..�.. .. ..�..-- l ( ------�------ ;; - -= r I ----------------------•-- ------------ ------------------------- I ----- -------- ------------------ ----- ---------------- ---------------------- ,'... ' ------------------------------- ---- --------- --------------------------- FINAL INSPECTION_BY:------ - - __ - __- `�`.._- _Date _ -3''_l 3 --------------------------------------- --------------- SAN --------------------- ----- -- _.-------------- 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.CQ.