10286 - Laserfiche WebLink

Home Browse Search

r APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ' Date Issued _____-6Aa___ n S8_Od o,- Z-b •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 Ord',ante No. 549. T (}U,.SE: f•, F JOB ADDRESS AND LOCATION `------------ ------- t 0 lye. t Owner's Name-,-) ame-- � --°------ �U- ------------------------ --------------- Address - ---------- Phone-r741....r� ice!-Ci 1- !, a?_ _�.._ �"� �/� Address-------------'��- �--:----------_ � ��- -c�'O-t- ----=Y---��1��--------------------- -------------- ._.- , --- - - -- --- -- ------- Contractor s Name �I + fl - s,� 4 - f mal Tl� f 6---- Installation will serve: Residence A artment House Commercial Trailer Court MotelOther i Number of living units: ____ _ Number of,bedrooms __'Number of baths ________ Lot size R.... C #o __ _____________ Water Supply: Public system ❑ Community system ❑' Private $, Depth to `ater Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe [❑ Hardpan ❑ Previous Application Made:: Yes F] No ❑. New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we __ _______f_Distance from founclation_.___0-----------Material__, _ e p y� is= -- �----------- 0 fi F Nn, of compartments__,--� '-,w--:_Size-,��j--�� _ ___--Liquid depth-_� ----�--.----Capacity------ --x.41___-- r Dis osal F eid: Distance from nearest well_ r_Dis ante from foundation___ __ Distance to nearest lot line__ _.__.. ��`` � fib � � ��i © S Number.of lines_____Y_ e_ `> Length of each line_ _`-_____fid_ ^.Width of trench--_" ca4_`_•__-___ Type of filter material t X12! Depth of filter material___.P_ p_f_____._Total length------------ Q ____Distance rom foundation__-..�_.__.._p___.Distance to nearest lot line__.______ Seepage Pit: Distance to nearest well__ _ __ g �1 '� ! Number of pits------ ---------h Lining material_-�__ @-4 _ ----Size: Diameter-_44--------.Depth----,�_ ---------------_--- Cesspool: Distance from nearest well-----------------Distance fromoundation_____- ----------Lining material________________-_____-_____________ ❑ Size: Diameter-------------=---------- -------------Depth------ ----------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__________________---- ----'-__Distance from nearest building-____-_______--_____ ❑ Distance to rearest lot'line__'_____ - � L __ Remodelingand/or repairing t , n -f:-rs- .t -r� ----- - / p g (describe):_ - -41 A -----------=---------------•--------------- ----------- ----•---•_ --- ----------°--------------•-----------L---•--•------------------------------------------------------------------------- ------------=------------------------------------------------ --------------------I------------------------------------------------------------------------------- , , ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 r (Signed)..` �----- ---- V C' ---- - -----------------------------------------------__�wner r Contractor) By:----------------------------------------------------------------------------------- - ---- --- ----- --------------(Title)---------------------------------------------•----------------- (Plot plan, showing size of lot, location of system in relati to wells, buildin , etc., can be placed on reverse side). FOR D PARTMENT USE ONLY -- y DATE__f' APPLICATION ACCEPTED B�r�..-------- ----------------------------------------------- ----- ----- ------=------------ �---------------------------------------------------- REVIEWED ----------•-------•------•------------ ---------- REVIEWED BY DATE °�.- ---•---------------•-----------------------•------, BUILDING PERMIT ISSUED; - j - = " "" `` A_!_1DATE Alteration"nd/or recommendations t--------------------------------------------------- � ____ �� `- ________ -t ------- A ____ ------ ------------------------------------ -- - - - ---- ----------------- -----------ff----------------------- ---•----------------------•------------------------ ----------------------------------------------•----------•---------------------------••------- ----------------------------------------------------------------------- ---------••----------------------•---•--------- FINAL INSPECTION BY:. - Date - rp 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 , Revises 1-57 P,P.CO.