10298 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No....-.- J�(11/ho A Y [Complete in Duplicate) � Vf Date issue ."".,------------•- i ` it to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health Distract or a perm This application is made in compliance with County Ordinance No. 5549. W--- --- - -•-- - --------------------------------------------- JOB -----•"---------------- •-------- JOB ADDRESS AND LOCATION -_-------- 1 ------- -------- -------- Phone_/Wo."".. h� a a- •------- -ate �. -Q--s _: Owner's Name ------------------------------------ - ---• -- Address----------------------------------••-------'--- ------- - - ""... 6 s -d---- -e a re --�-_ 4 Contractor's Name""""-"_-_.""�-a--� ---- � Other ❑ ,�artment House ❑ Commercial ❑ Trailer Cour} ❑ Motel �„ Installation will serve: Residence Lyr �p t.{ �_ e� ---------_---------- Number of living units: -----"" Number of bedroomswt- __- Number of baths., -----Lot size _"_. "�- - Depth to Water Table -3V ft. Commun'it System ❑ Private.❑ p Water Supply: Public system _ 1. Y Y Adobe Hardpan ❑ Character of sail to a depth of 3 feet:'' Sand ❑" Y rev} 4 ❑ ' Sandy Loam ❑ Clay Loam ❑ Clay ❑ Application Made: Yes ❑ No New Constructio : Yes ❑ No A/VA: Yes ❑ No Previous App TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or' cesspool permitted if public sewer is available within, 200 feet.) Septic 'Tan •a Distance from nearest well from foundati�quid depth Material.--_-_-- Capacity. "".---------- ---- W No. of compartments -------------------------- Size----- •- } F Disposal Field: Distance'from near,st'well,.-t-- Dafce if reach I ne orn ation -- __.W dth ofttre chest lot ine- -----" ------ 1 � Number of lines ------------------ -------Length, /V�^�-r ---De th of filter. material--- ------------- -----Total length ---------------------------------------- (J Ype of filter material---- ---------------- p / d .......... . .. Seepage Pit.' Distance to newest well _y}Q;n� Dteaa4Ee�YQ foundation Dl"��i �er"" a to nearest of . in� - t �% Number of pits-------)----- --- . g Distance from nearest well ---- .--- Distance`fron-; foundation--.-------- "---LiningCapacityaerial------------------------`-- ---- Cesspool: Depth --t------- ----- q------------------------ -- I ❑ Size: Diameter---------------------------------- Distance from nearest well -------------------- -----��--�--- - ----- Distance from nearest build'"sng---------------------------------------- Privy: "__""----------------------------- --� Privy:............................................................... ------------------ g ❑ Distance to nearest lo# ine"t ---- ------ . ". _ p Remodeling and/or repairing (describe)------------ I --- --------------------•--------------------------- ------- -- ------------------•-•------- ------------------------------------ -----------------•--------------------•---•-----------•--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Iaws, and rules and regulations of the San Joaquin Local Health District. (Owner r Contract � � ----- ------ ------ --------------- -----------(O and/or orj -- e.� r --------- -------------- } (Signed) ------------------------•-- .,,c �----------------------- - ------(Title)---- - •-- -------------------- --------------- -- i BY Y (Plot plan, showing si f lot, Iocation of system in relation to we s, buildings, etc., can be place, on reverse side). FOR DEPARTMENT USE ONLY DATE---_ A ''' i APPLICATION ACCEPTED BY - DATE ---_f --V 5-- `' ---- - REVIEWEDBY -------------------------- " ---------- :--- --- DATE ------------------------------------ --------- -------------- BUILDINGPERMIT ISSUED ----------------------- -t ----- '-- -------------•-------------- •-------- --------•--------------- ••------------ ------------------- Alterations and/or, recommendations:"--_"."..-------------------------------------- ------------------------ U ----------- ----------------------------------------------- F1NAL INSPECTION B :.--- ----- - /— . Date--- --------------------------------------- SAN - ------- -------=-----------------SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "G" Street 132 Sycamore Street 300 West Oak Street Tracy, California 130 South American Street Manteca, California Stockton, California Lodi, California ES -9-2M - Revised 1-57 F.P.CO: