10060 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ._.1 o V..�- (Complete in Duplicate) }/ $ 7�0 f Date Issued ---- -------!_•-----. Application is hereby made to the San'Joaqu'sn Local Health District for a permit to construct and install the wor herein described. This application is made in compliance with County Ordnc .ina :549. 1 1 JOB ADDRESS AND LOCATION-•---. `�`- f -- Owner s Name------ Phone. ------------- .r �, Address ✓ - ---------------- -------------- Contractor's Name rte- - +�`�- •�- - l�.. -;------------- ---- - Phon�-..------ Installation will serve: ;Resident ,�partment House E] Commercial E] Trailer Court E] Motel ❑ Other E] I Number of living units: ___ Number of bedroomsCh_.. Number,of baths _ _ Lot size 77 --- - ---------------•- r Water Supply;, Public system Community system'El'- Private ❑' Depth to Water-Table ft: Character of soil to a depth of 3 feet: Sand ❑ ravel ❑ Sandy Loam ❑ Clay Loam_. Clay ❑ Adobe[] Hardpan ❑ Previous Application Made: Yes E] No I ew C nstruction: Yes E]. No FHA/VA: Yes ❑ NoC__* TYP INSTALLATION AND SPECIFICATIONS: :.. (No septic tank or'cesspool permitted if-public sewer is available within 200 feet.) p�tic Distance from rsea_ st well------- . _ Distance from foundation--------------______.Ma#eriaL___. ___.____.__._____ -_________...._:____... s ' Size---------------- ._Liquid de th---------------------------Ca acit No. of compartments-------------------- - --- ---------- q p. � p Y---------------- -----• d: Distanc6ffro nearest well . __...._.Distance from foundation-------- ------_.Distance to nearest lot line----_...._-_._.-_ un ,.x t.. 9 ------------Width of trench--------- ----� Total length Ypiber of lines -�------------------------------= -Le P th.of each line----------------- g . -------------------- T e of filter material--------------------------nk _ __ De th of filter material_`---------------------� � Seepag i�. Distance.to nearest well JZ .p Distant fro foundation-,!____ .Mitpp to nearest lot line-�'._--_ Depth_ _ Number of pits - _-__ __..__ Lining material h ____ -_-size: Diameter_:}_ _____ Cesspool: Distance"from. nearest well----------------- from foundation-------------------Lining material------------------------------------- [1 Size: Diameter--------------=---- - ------Depth____ , -------I-----•-------------�: Liquid Capacity gals. R . ,, . r Privy: " Distance'from nearfest Weil '.`---------------------------------------=---Distance from,nearest building-----------------d ------------- --------------------- ---_.-._ ❑ -�-4,Distance'to,nearest lot line._-:-:. -_. .,...,,_. == - --•-- . ---- . - . ---- r I _ Remodeling and/or repairing (describe): ¢ I f'h�c, --�-^ = -----•-------------------------------------------------- ' - l------------------------- -------- -------------------------• - -- ----------- ---------------------- ! -------=---------------------- = -------------- - - - ----- ----- - - --- - -- - - -- -•- •--.----- •- ------ ---------•--•------------ ---------------------------- - I hereby certify that I have prepared this•application and t t theme" rk will-be done in accordance with San Joaquin County ordinances, State laws, and rules and re uletions of the San J in' oval H alt District. DAY&NI�#IT ; 03 (Signed) 4 �10!taotion tJIC [tlt_S4S .. ------ - Y - ontrattorl CBY� ckton;Gzrli#: ------ ----- (Title] -- ,buildings, P ).(Plot plan, showing size of..ot, of system in,relati we c.,.can be laced on reverse side FOR WARTMENT USE ONLY APPLICATION ACCEPTED.BY- - ----------------------- DATE ---------1 REVIEWED BY------------------------- - --------------------------------------------------------- DATE------------------------------------------------------------ t BUI LDI NG PERMIT ISSUED-------•---------------------------------------------------=- ------ DATE-------------------------------------- -------- ------------ Alterations and/or-recommendations:------------- __ `--------------------------------- --••-----------•-•---------•-•--------•----------------- ----------------------------- -----------------------------i----------------------------------------------- -----------------------------•-•------------------------ ------------------------•---------------------- -----•---------------------- ---------------- ------------------------ ---------------• - ... ----------------------- --•------------•------------------- -------- ------ ----------- --------------------------- ------ ---------r-! ------- ------------ -------------------------------------------- -------------------------- ._.;. ._ _ . -.--- -- � �:.- Date_..°:. -�=- � - FINAL INSPECTION BY______________________-.-_--___ J , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Sfreet Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M , Revisea 1.57 F-P.CO_