11414 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No ..... �� (Complete in Duplicate) Date Issued --- oY App Fi_RWefT66!Ari e� it" ib�rbljye�T_ !?f 6� f h e San Joaqu in Loca I Healf h D i sf ri ct f a r a permit to co n stru ct a nd in sta 11 +h e work h ereinZA c ribed.. This application is made in compliance with County Ordaine No. 9. JOB ADDRESS ANP W --- ----------------- -- - --- ---- ----------- * ------ .............. 7 CATION .:O� --- 0- _-, --- �__ _--te-4 ---- Owner's Name_ -_ 42111K_�_k -------- __4,___ S_ Installation will serve: Residence A p a enf House F] Commercial E] Trailer Court E] Motel F] Other Number of living units: --t ---- Number of bedrooms ____'2-1qumber of baths I ------ Lot size ------------- Water Supply: Public system E] Community system El PrivateX Depth to Water Tabld-5-t ft. Character of soil to a depth of 3 feet: Sand C] Gravel Ej Sandy Loam F] Clay Loam 0 Clay Adobe.0 Hardpan E] Previous Application Made: Yes E] N ew Construction: Yes No E] FHA/VA-, Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ---- $10 ----- Disfar1re-efrom un, Oon ---- -------- Material ------- Dis a[ Field: Distance from nejrpsf Distance from founclafir isfance to nearest lot line -A? ---------- Number of lines -------- Length of each *74 -7A.Width of trenc e 4F 4 Type of filter ma_�erial!OT��_ --- Depth of filter maferial- length -1- ----------------------- Soepnge Rt: Distance to nearest well ---------------------- Distance from foundation -------------------- Distance fonearest lot line ----------------- Number .--._- Num6o, of pits. -�'��-Lining material ----------------------- Diameter -'''-'''-- Depth '-'�-'-'__''— Cess000l: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material -----_—_._ Privy: Distance from nearest well F1 Distance to nearest lot I�ne_ ---- ------ R__-_n------------------------------------- ----------------------------------------------------------- -------------------------------------------------- ----- --.__---__----____-----_-___---_-_-'_.__.--_----__. .. .--__—_-_..__-___._.__-_---'_._----__-_-_----_---__'_--__.__.._.__-_--.. '----------'----'----''--''----''---'---'------------------'--'--'—'-----'---------' I hereby cerfif at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St 5, and rules and reg6tionsegf the San Joaquin Local Health District. (Plot plan, showing'size of lot, location of system in.relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y_ DATE' REV|EWED BY DATE --------- BUILDING - 8U|LD|NE� PEkW[T ISSUED __-__.''__.--~��'��---.-------�'--------�''-_.' DATE --'_--''----_''---'l-'____�' ------'---''--------'---''--''-''-''--'''-''''---'---------'---------------'-----'------ ----_--------___------__---____-----_-----------__��_----__---__------____---___�_-----------______��_�- --------- ------- ---------___----------------------_--------- __.__-_--_---'___--.__---.-------.---'__-.___--_-_----_'-_---.-_'-___. —'--'-'''-''--'''�'-'�'�- �---''''''��-------------- -'''--''�---.�''''-''�---__''-'-- �..�~��4��.�---.- D��u-----.�-_~�.� -------.F|N/L INSPECTION BY: --�� - SAN JOAQU|N LOCAL HEALTH DISTRICT moSouth American Street Stockton, California ES -9-2M , Revised 1-57 FPrCO- 300 West Oak Street /sz Sycamore Street ww w°*h ~r' Street u,dl. California w°"*"c°, California n~cv California