10584 - Laserfiche WebLink

Home Browse Search

so-vs-1 , APPLICATION FOR SANITATION PERMIT Permit S_ .!____._ (Complete in Duplicate) // Date issued ______ _? -_______ Application is hereby made to the Sari-Joaq'uii'Local'Heath-D sstrICf"for p rmit'to consfruct and install the work herein described. This application is made in compliance with Counfr-Grdinance No.. ) 449. r r " JOB ADDRESS AND LOCATION...rr ---- OOr ------_, �U ------ 11 I_ - Owner's Name---------------EDWARD_------------- Qr'.P*,--1<---- - ----{--.---:------------ ---------------------- Phone-----NQN?F-------------- Address_ Contractor's Name -----------•---------------[------------------------------ Phone Installation will serve: Residence Q'.Apart�ent House ❑ Commercial ❑4 Trailer Court El Motel ❑ Other ❑ Number of livingunits: __ ___ Number of bedroom _*hs __)___ Lot size ________________ s _._ Number of bat Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table •i9__ ft. Character of soil to a depth of 3 feet: Sand[] Gravel ❑ "Sandy Loam �' Clay Loa l ❑ Clay E❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Nll' ew Construction: Yes` o ❑ FHA/VA: Yes ❑ No ❑ � f TYPE OF INSTALLATION AND:SPECIFICATIONS: (No septic tank or'cesspool permitted if public ser is available within 0 feet.) ll' t / Septic Tank: DistanceW from nearest well-10 .-Distance from foundation---�d_____ ------M t�rial____RjEDW_Q© No. of com artments-------- —_ _Size_ Liquid depth---- __ Capacity------ Disposal Field: Distance from nearest well-,140-0 -Distance from foundation----..____-_____._Distance to nearest lot line__�5_-_____ Number of lines----------- ' 3_0_-Width of trench_---_2`�- �....___ _--___-____ _Length of each line_fj_Q"� � Type of filter material_'_-Q_ ,_Depth of filter material---. _--Total length----------/ O__________________Seepage Distance to near�t,well__NP/_J>�--__Distance from foundation___7a?______.Distance to nearest lot line___ -- ----------- Number i�umber of pits__-:__ ------ _Lining materiaL_ 04- ___.5ize: Diameter___ e O=__.£ �__- -- Cesspool: Distance from nearest well______________ _Dis#ance('frbTri foundlition_____-----__-_____..Lining maferi�_. .b____._______-________. ❑ Size: Diameter.-------' ------------------- epth------ '�^�'. -` Liquid Capacity = = gals. . Privy: Distance from nearest well _------------------------------- �D istance from nearest building----------------------------------------. ❑ -' Distance to nearest,lot.line 4---- ----------------------------------------------------- ----------------------- -------- ---------------------------- I }� 411 /y , ,. Remodeling and/or repairing (describe):__ -SlJ � TVT -------- --:--`- t-4�I S /--�---1Z)--X--6---------------- ! T D--•--D_-------V1 xT�-----}�_-t-= -------------a.-----x--�'-- -----------------'--------- - - ------------------------------------------------------- -------------------•---------------------------------------------------------------------------------------------------------------- ------------------------------------------- I hereby certify that I have prepared this application tan&that the work Will,be done in accordance with San Joaquin County ordinances, State laws, and ,tyles and r6gulaiions of the San Joaquin Local Health district. ------------------------------ (Signed). ---- -- i -------------------•--------------- ------- -----(Owner and/or Contractor) 1 BY: = i - -----------------------------------------------------------------------(Title)---- ----------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENTyUSE ONLY__—J APPLICATION ACCEPTED 13Y------ ----- --- ------- -I--------------------------- DATE-- REVIEWED BY BY--------------------------------------------------------------------------------------------------- e III DATE -•- - -------------- BUILDING PERMIT ISSUED-------------:------`------ =""`' ------•--------------------------------------- DATE---------- Alterations and/or recommendafions:- { ff ----------------y--------------{----------------------------------1-•----•------�T------------------------------------•------------- ----------------------------- �© ! �--------0` __J `IS.� _ ' ZZS -------------- ------------- - - - e -------- ----------------------- --------------------- ----- - - -- = "' --------I-------------------------- --------------------------------------------------- FINAL INSPECTION BY-_- a� e�7Date - 1 �----------------------------------------- :. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streat 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A , Revises{ 1-57 F.P.Co-