10582 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) �1 -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 County Ordinance 549. JOB ADDRESS AND-LOCATION_. - - — I+ ' Owner's Name ._-- y - ------- ----------------=--- ------------------= . -- t Address--------------------------( ---- ---•-�-��_��_ --------p-------------------------- --- �/_ / Contractor's Name______ _____________ _____ '_ _ Phonel"1-•�d - - ----------------------- -------- -- -- Installation will serve:„lResid1ence Apartment House ❑ Commercial'❑ Trailer Court ❑ Motel ❑ h Other E]Number of livin units: ___ ___ Number of bedrooms __`Number of baths : _---- Lot size --- " r Water Supply: Publiclsyste' Community system ❑ Private ❑ Depth to Water Table�7 ft.,- Character of soil to a depthyof 3 feet: SandGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ t Adobe'®' Hardpan ❑ Previous Application Made:iYes ❑ No New Construction: Yes"❑ No 2" FHA/ A: Yes A N TYPE OF INSTALLATION AND SPECII"ICATIONS: l (No septic tank or'cesspool permitted if public sewer is available within 200'feet.) r . j . . _ .,._... ptic Tan Distance''from nea est well_________________Distance from foundation___- _-:.__-_ .___.Material__.___.._.'- No. of compartments ''ize ------------------------ Liquid del�h ------------- --Capacity-------------- -------- sal Fiel Distance from neaest well ----�----- --Distance from aundation r_------------ ____ ____-----Distance to nearest lot line----------------- Number of lines-__- -- } en th of eat line-_-:__i ------ --------Width rof trent h---------------- - - -------- Number, Type of 'filter material___ -f`._____..__�-_Depth of filterfmateriai-----.-_-.---��-/- potal stance gtohnearest lot line___�_�____ Seepage Pit: Distance,.to nearest Lin�7 Distance from founds z enDi�ameter._ c __._I______.De rest Numberl6f pits__ g .. � ...--.oto � 5 r p ��- -------- h� 1 " ~� I t Cesspool: Distance from nearest well_ ______ ___Distance from•.foundtron.___...__..__A_ Lining rnaterial__.__._._-___ Q Priv Distance from nearest well---------------`-------- -----------------------_Dis.tan� " -------- � --'---- Liquid Capacity---_--------------------•---gals. ❑ Size: Diameter-----------------------------------------Depth---------=----=--- - ---Y•' Y: stance from (nearest building------------------------------------------ a Qistance o neares "lot fine______ _ - -- -- --------------- __ �^ ` -- + - ------- --- - - - -- - - ------------------------------ Remodeling and/or repairinl (describe): - �� c__ � -tea-- -------------------------------------- --------- ------------------------------------ --------------------- -----:--------- ----------- ----------- -- - IM _ ---------------------------I ------------------------------------------------_____________________________________________•__---__-_----_______----_-_-_-------____-------_-_-----_-_-_--------_--_-.--__--____---__-.-__-_----.--_-._-_-.-_-_______._.___- I hereby certify that I heave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, +e laws, andrules a d regulatd s of the San Joaquin Local Health District. ' [Signed) -' "�• ----- - -C; 4 (� Contractor) �- i - ------ {-------------------------------------- (PlotY--------------------------------�-----------------'------------ ---------------------- -- --�'_---- --------- --------{Title)--pian, showing size of lot, location of system in re to wells, building +c.; can be placed on reverse side). I. F6eDEPARTMENT USE ONLY APPLICATION ACCEPTEp,h. & ------`--- '' = ----- DATE S REVIEWEDBY------ ------------------------------------- ------------------------------------------------------ DATE------ --• - -------- BUILDING PERMIT ISSUEDA----------- ---------- -- -- --------------------------------------------------------------------- DATE-. . --------------------------------------------------- Alterations and/or recomme dations:------------ ----------------------------------------------------------------- --------------------------------------------........----------------••------- I --------------------------------------- ----= -------------------------------------------------------------------------------------------------------------------------------------•----------------•---------------- ---------------------------------------------•-d--------------------------=--------------------------------- ------ -------------------------------------'-----------------------------------------------------------------•--- .I[ N ------------------------------ ----------------- ------- � ----- ---------•----------------- - FINAL INSPECTION BY:_4 _..__. _.__ - ----- ----------------- Date-------- ------ ------------------------------------------------ SAN -• -----SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West'Oak Street 132 Sycamore Street 814 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California €S-9-2M , Revised 1.57 F.P.CO. IN