12782 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE: ---------- --------------------------------- ------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----- --------------�el-- ------------ - ------------:------ (Complete in Duplicate) - --------I------ --------------- --- -This Permit Expires 1 Year From Date Issued Date Issued ......Lih ------------ Application is hereby made to the'San 'Joaquin Local Health District for a,permit to construct and install the w her in escribed. This application is made in compliance with-Gounty--Ordinance-No.-549—.-.-,. JOB ADDRESS AND LOCATIONJ -------------- -----------------_-----------_---------------- .... ... e Owner's Name-------------- ----------------------------------------------------------------------I---------------- Phone------------------------------------ Address-----------------_- ------------------I----------I--------------------I_....................................... Contractor's Name------------------_ S�. --------------------------------------- --------- Phone.Kabc".&--------- Installation will serve: Residence 2� Apa'rtment House ❑ Commercial El Trailer Court [3 Motel 0 Other E] Number of living units: -A..--. Number of bedrooms --- Number of baths ____I__ Lot size ----!kP_1----XA_&--__- Water &-----Water Supply: Public system 16 .Community� system C] Private F] Depth to Water Table ft. 4 t Character of sail to a depth of 3 feef:-'�Sand Ej Gravel E]- Sandy Lo�m E] :Clay Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: (If yes,clatr. e- -------- ---------) No & New Construction: Yes-9[ Yes El Nod{] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted lublic sewer is available within 200 feet.) ��__Distancp from four --------M Septic Distance.Ifance from n1 p Tank: ea�esf well--. oaf ion------ 6feial---attv_ No of comparti Size--rZ. Distance from fo-'und;t* --------- ;ents------ Liq u id d ep�h----4-- ------ --------Ca paci Disposal Field: Distance from nearest weI.I.___f1-__.__� in stance to nearest I mber of lines------- L th of --- idfk-of trench--9,1, eng V -A Type of filter martoi ��-- -- --- Depth of filter material--- ,---------Toid length- N u --- �ach'li_ne --------------------- Seepage Pit: fDistance to nearest well_____ _____________Distance from ---- -------- ofoundafion-..;��—!�R..-..Disfance to nearest lot line--- ' ---- Diameter_ Number of Lining maferiala�,__ _� A, V ---------------- Cesspool: i. Distance from nearest we}l-----------------Distan-cel-from foundation-------------- -----Lining material____-______--_-________._____________. El Size: I r --------------------------------------------------Liquid Capacity-.--------------------------gals. .,I i----------'------------------Depth- Privy: Distance 'from nearesf well,------- ------------------------------m_Distance from nearest building------%--------I------------------I Distanc❑ e fonearest'lut'li ------------- --------------------------------------------------------------- -------------------------------------------- Remodeling and/or repairing (clescribe):---------------------------------------- - --------- --------------------------------- ----------------------------------------------------------------- ------------------------ ------------------------------------------------------------------------------------ i -------------------------------- ----------------------------------- --------------- ---------- -----------------------------------___________________________________________________________________________________________________________________________________________________------------------------------ ---------- --------------------------------------------------------------------------------------------------------------------------------------I� — r.- - --------- ----- ------- ------------------------------------------- i MAi - that-th-af-A work will,be,d8nje iin"_ 'rdance with San Joaquin County I hereby certify that I hava orepare is ap 67W acco -ordinances, Stle laws, and rule's and r ulaflons of the San Joaquin Local Health District. g�i (Si e ---------------------------- - ------ ---- -------------------------- i i -(Owner and/or Contractor) rv!��-------------------------t---:------------------------------------ --------------------------------------------(rifle)----------------------- ----------- ------ --------------- - ------------- (Plo+ plan, showing size of lot, locafic�n of system in relation to wells, buildings, etc., can be placed on reverse side). J FOR DEPARTMENT USE ONLY -------------------- APPLICATION ACCEPTED BY----------------------- ------ - --- ------------ --------------------------- ----------- DATE------- €3 BY_-.--------------------------fL : --- ------------------------- ----------- --------- DATE-------- ---------------------------------------------- BUILDING PERMIT ISSUED.-•- ---------- I ------------ T-------------------------------------- DATE_-------------------- Allferafions.and/�or recommendafions: Z- - --- ---- ---------- --------------- -------- ------- --------- ------ �_ _-71 ----------------------------------------------------- ------------- ------------------------------------------------ ------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ ------------ •--------------------- ------•---------- ----------------------I-------------------- --- ---------m---------------------------------------------------------------------------- --------------- ----------------------------- FINAL INSPECTION 'BY:------------- . ....... ----- --- ----------------------- Date-------�- - ----- -- -- ---------- SAN JOAQUIN LOCAL HEALTWIDISTRICT 7f to i 130 South American Street 300 West Oak Street j 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CM-9 REVISED 8.50 F.P.CM 2M 15.460