4708 - Laserfiche WebLink

Home Browse Search

APPLICATIOW FOR.SANITATION PERMIT Permit No. -- (Complete in Duplicate) j s Date Issued --- Applica+"ion 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 Q-rd7nan No. 549- 4 . __ a - JOB ADDRESS.A -LOCATIO -:-- ------•----------------;---- -•--•------------------------------------- -- --- ----------------------------- - Owne i Ph G2 r s Name__ "`.' - - „i one_ 1 - - -- F --------------------------------------- - ______ ________________ Address • ------ ------------ - = = =- -' I .. r 1. ' ' ' --;------ °-- ?--- � Contrator's Name _ p --------------- •------= Phone Installation will serve• f Residence A artment House '►Commercial ❑ Trailer'Court W.Motel 1[4 Other ❑ yy /p�' lNumber of living units:1 _ umber-of bedrooms 1�Number of baths �_U. Lot size Water Supply:-Public'-system ' ' Community'system E1" Private E3Depth to Water Table __':___: ft. . s Character of soil to a depth of 3 feet: . Sand Gravelt❑ Sandy Loam lay Loam ❑ Clay E] Adobe Hardpan El Previous�Application Made: Yes ❑ No R New Con struction:,Ye's goNo El TYPE-OF INSTALLATION AND SPECIFICATIONS: ILI i (No septic tank or cesspool.permitted ' u6iic sewer is.available within 200feel.) Septic ank: Distance from nearest well___ _ `Dista�e f o afpu ation_________ _______.Mat rip I -------- ------ x_ ' _Size_ Li uid de th__ ___ _ _ ..___ Ca aci . of compartments------- -_- q P --- p ty--��J� p Dis os eld: ..Do Distance from found tion/0-'!---7-Distance to nearest lotine __ ----- --------- /o Width of trench. tante from nearest ll_.: _Ad Distance of lines._-•-:_-- - - Length of each lin -_ � � - /-=-•------- f ryP '4 "p a t .. / 6-'----Total length------------------ T e o filter mater - ___ e th of filter rnateriaL__.___: It, Seepage Qistance to nearestwell__ - _Dis fiance from fou,dation_______ -__ Distance to nearest lot line--------------- -Pit. ;,.� - - ❑ Number of pits--_._____ ---------Lining material ____ Size. Diameter_ Depth-------------------------- . Cesspool: Distance from nea est well"_} °-Distance from-foundation"..._ .:. Linin material____________________ Size: Diameter_ =i "Depth - -----.^-•-�.- -•,Liquid Gapac ty ,ems Y ___ga1s. — _. __ Distance from nearest building ______' .-_._._. Priv❑ --�-- Distance to ea essttDistance from. elotst ,l nle - � - `r -_ =- i . • Remodeling land/or repairing (describe) _ -------- --- - ------ --- - - -- .. 1 -------------•------------•-----=------ ,. --------------------------------------------------- ---------- ....--=-------•-------•------------------- E - --------•--------- t - �--, y,-w•._ �..�.�.d. �. 'r. `_ :=_---— ---- - •• ----- - •----- ----... `` --- Thereby ce. ify-that I have pro red this application and that the work will•be'done in accordance with'San .Joaquin County ordinances Sta.e laws,. and rules a d egulations of the San Joaquin Local Health District, y i (Owner Contractor) (Signe -- ---- ,,.1 ------ ------------ -------- ----------------------------- ----------- ---- --(Ow and/or tor) ' --_-----_-'`_(Tit e)------------ By:._. _. 4j - ---------•------ ------------------------ --- (Plot plan, showin 1Z lOt, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY- ---- ---------------------------------------------------•------ --- DATE_ REVIEWED BY------------------=---------- -------=-- --- }--------------- ----------------------•--------------------i.. DATE ------------ BUILDINGPERMIT ISSUED-----------------•-------------------------•----------------------------------------•------------._ DATE------- , Alterations arid/or.recommendations:------------------------------------ ------- ----------------- --------------------------------------------•---------••-•--•---•--------- t i --- ii --------------------------------- ---- ----------------------------------- -------- --------------------- ! I :. ' -----------------------------------=----- '----------- ------------- ---••---..... - -------------b------' - a .� , ._•', _ ..� .-- -3 T FINAL INSPECTION BY:- `_= - Date - r'_" ' 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 Revised W-2100 /^