9213 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) Date Issued --- gA plica+ion is hereby made f6' the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance mpliance with County Ordinance No. 549. ZP I ------ I �r ------------- JOB ADDRESS AND LOCATION_ ----------------------------------------- Own6r's Name----------- !.Al----------- ------------ _- ---------------------- ------------- Phone- Zf_ Address-------------------- __.;------ ------------------ --------------------------------------------------------------------------------------- Contractor's Name----- ------ ---------------------------------- Installation will,.servp.--"Residp`nce-$-4 -a.r'tment House [I Commercial [I " Trailer Court [I Motel [3 Other ❑ A Number of living units:;11 Number of bedrooms ---/-- Number of baths ___t___ Lot size -----� ----x -/C?_0--------- -------------- Wafee Supply: Public 5ysterii Community system [] Private F1 ' Depth to Wafer Table ft. Character of soil to a depth 61.'3 feet: Sand E] Gravel E] Sandy Loam E], Clay Loam Ej Clay E] Aclobeg Hardpan Previous Application Made: Yes E] No X New Construction: Yes El N 0(9 TYPE OF INSTALLATION AND SPECIFICATIONS - "I%�, I N (No septic fank, cesspool permitted if public sewe,is avai.a-e within 200 feet. 'iTr �.,I , .__ - — __ --- - -_ 9.�� Septic Tank: Distance from nearesf well-----------------Distance from foundat;on-------------1 -:.---.Material-------------------------------------------------- El No. of cd'"mparfments-- ------------------------Size...... -------- ------------_Liquicl depth------------------------ Capacity----------------------- Disposal Field: Distance from rre_aresf�—well.-I---------------Distance from foundation--------------1--,--.Distance to nearest lot line----------------- ❑ Number0 if lines-------------- - --- Lengfh"of each line------................. .....Width of trench---------------_.------------------ 4 . Type of filter material-________- --------------Depth of-filter materW-----------------.-----Total length_:_____-_--_-__________ _______________ G�� T Seepage ength--------------------------------------- • Seepage Pit: Distance to nedrestnwell------ Distanc4r[.�crn foundation___oZ0._:!---- DistanW to nearest lot line-'--y------ Number of pifs)_::-�7_1�1-----�Liriirg �aferia I/_A!W1C__Size: Diamefe'r------(411r��n-----Depfh----,2-,s—------------ I ; NJ - a Distance n Cesspool: tancejicim nearest.well]Z.'---------t Dista/ce from foundaf ion__ Linir�,9.material__.____________:___________________.: ic4 Dep ---- ------------------------Liqbia Capacity----------------------------gals. El Size: Diameter-__--- ----------------- Privy: D+sfance from nearest well-le—L-44 -------------------------------------Distance from nearest Building------------------------------------------ it�`e' "71, .. _-4- •!- ------ ❑ Distance to neareTl-.I-1- -------- -' --------------------------------------------- ----------------- ----------------- ---------------*---------- ae- 0� Remodeling and or reRairing,;(describe):--- _ff - -----------do*jg�".^n..........jA_7y's_* --------------- --------- 7- P72 k----....70,0--.�---------rI.0V__/X//__Z,-1A/`a7---------7"a----------- -------- ---- ------------------------------- --------------------------------------- -----------------------I--------------------------------------------------------------------I-----------------------------------------------11----------------- --------------------- ------------------------------------------------------ ------------------------------------------------------------------- -----------------1------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San,Joaquin Coun ordinances, State laws, and d regulafic;ns of the San Joaquin Local Health District; J ......... (Signed,-• �___ _____________________[Owners and/or Contractor) By:-------------- /1 /ZC4------------:--------------------------------------------------------------------(Title)........ —------------ (Plot plan, showing size of lot,�.locafion of system in relation to wells, buildings, etc., can be placed on reverse side). u. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ------------------ DATE-- ------------------------------------------ ii� " ------- - -------------- -------------------------------- -------- REVIEWEDBY------------------------ _------------- ------- ------------------------------------------------------------------------- DATE_------------- -------------------------------------- BUILDING PERMIT ISSUED '1----------------•------------- -. DATE �r\ 0 -------------------------- ----------------------------------------------- -- ------- ------------------------------------------------- s and/ ndafiz J! A r --- - ------ - --------------------- ------------ -------- J-1,10 c ---------I-------------- ----------- ---------- 0.... ------0 --- --- --------------------------------------U.-:----------------------------- ----------------------------------------------------------- ----------------------------------------- ----------------------------------- ---------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------I--------------------------- --------------------------------------- ---------------------------------m-------•---------------- ----------------------------------------------------- FINAL INSPECTION 'BY:..-:---------- ---------------------------- D&te--- ------------------------------i}----------------- SAN -----------------------------I------------------ 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