9358 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..P_ (Complete in Duplicate) t(. pats Issued -------A��-7.. Application is hereby made to the San Local HeaEth District for a per it to construct and install the wor rein described. This application is made in compliance with County Ordinance C. 549. JOB ADDRESS AND LO ATION....._.3 SG} _.. � - --------------------- Owner's � Owner's Name r� --------- ! -- E rt �._ Phone-. . - - -- Address--------------------------- - - ----------------------••-------- .............. ----•-•----•�-----------•-•---.._._.------ - Contractor s Name--------- ----- ---=-- �-- ----..-----------�=--•�- ---- ---- -------------:-----•------• -......-------- Phoner�-- --r--�®� Installation will serve: Residence E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---(-.-- Number of bedrooms 2- Number of baths ---I.. Lot size ------- ___ ?.f_ _ ___.p__I. ............. Wafer Supply: Public system r[-Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe UEr Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No LJ TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank or'cesspoo[ permitted if public sewer is available wifhin 200 feet.) etic T A: Distance from nearest well---------------t_Distance from-foundation-------------------.Material---------------.----.-.,----.----_-..____-__----. _Capacity No. of compartments_ ----"• .+ - - ---Size--------------------------------Liquid.depth------------------------- ---------•-- to , ; Distance from nearest well__f`�_�'' .Distance from feundation__________ .._Distance to nearest of Eine.__ --- _. Number of lines_____#1_____ _ _____ _____ ___ Length of each line_. _ Width of french_--_ _'� - -------- Type of filter material_ __ _Depth of filter wmaterial------- --- ---Total length--.------_--_-_-..--.--- pag if- Distance to nearest wekl__�I ___Distance rom foundation__�_CJ_----._..Distance oto nearest lot line------ � � ' p' g ------ - . r ------ ;. ----_ � ��--- ----.Depth----,�--,�---------- � Number of 1ts_________________ Linin materia_. _- �� ._.Size: Diamete Cesspool: Distance from nearest well________________Distance from foundation.-------------------Lining material__.-_----------._---.---------------_. ❑ Size: Diameter---------------------- ----------- :Depth i----------=---------------------------------------Liquid Capacity----------------------------gals. ..._Distance from nearest building 'V Privy: Distance from nearest:weUl ------•..__. g------------------------------ ----------- I ❑ Distance to nearest lot•line------- -"^ Remodeling' and/or repairing {describe)---=-----= ------ --------------- -- ------------------------------------------------•--------------.."._._.........---------= --------------•------------------------------------•---;---•--•-- ---------------•-------------------------------------------------------------------------------------------------------------------------------------------- ---- I hereby c rtify at I have prepared s--application an hat the work will bedonein accordance with San Joaquin County ordinances, Stat I and rules and reg Cat* of the Sa aquin Local Health District. (Signed)--------------- ------------- ------ ------------- 4 t Vr Contractor) By:------------------------•-----•-------------------------------------- � -----------------(Titl �- (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can bye aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY F----------------------------=--------------------------- DATE - REVIEWEDBY------------------------- - .. --------------- ---------------------------=------------ DATE ------ ----------------------•----------------- BUILDING PERMIT ISSUED----------------- - :_. DATE --------=------------------ Alta tions a d/or recommendations:- --_ r--- -- -------------_-ry--•----•---------- ----- ^^ 4 -- ---------- ' = t -------?-J��-------- .?....-�N`a"'Sc�F_h�_ �__--.'��-"___________________�..--._______. __________----- -------------y--------------- ---- --------)------------------------___________________._______._ ______________________________________._._-__-.-----_--.._--.--.__---__------.---__------_.__-__-__._-_-_-`_.--_-_-.--_---------------_.._.--.__----.—._..-._.-_-_-_---.-,_.-__--__-__-•-.-__-___-..._--..--__--__----_---__. 1 , r� FINAL INSPECTION` BY::--------- = __ :_�----------------- -- Date-�-=�I!`.'��`� � ---------- ----------• ...----------------- 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 , Revisep 1.57 F.P.CO.