14395 - Laserfiche WebLink

Home Browse Search

FOR OFFI E U E: r •---J,�---•1-•- �-- �. ----�� - APPLICATION FOR SANITATION PERMIT Permit No. _..�••- ------ ' 4 ,_11 ---- ________ (Complete in Duplicate) Date issued ......... ......f--- - � - This Permit Ex Ives 1 Year From Date Issued . ---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance No. 549. s .. .. .........................................•-•----•-•-•-•-•-•--....__.. JOB ADDRESS AND LOCA ----------------- ------------------------------------- ---- l •------•------•------- Phone -•--- --- Owner's Name_...-------•----•------ ---••--••---•--•--•--•----.. 62 Address ' - �`.' -1 one.----------••------•--•-••--••----- Contractor's Name_.._ -----• --------------•--------•---------=----•---••- -----------•---------------- Other ❑ j Commercial ❑ Trailer' Court ❑ Motel ❑ p Installation will serve: Residence Apartment House ❑ 1, Number of living units: ._ Number of bedrooms _-2: Dumber of baths - _,Lot size ._ Water Supply: Public system Community system ❑ Private ❑ Depth to Waters Table, ft. 4 Adobe ardpen ❑ 4 Character of soil to a depth of 3 feet:. Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ No ❑ Previous Applica+ion Made: (if yes,date____________________) No ❑ New Construction: Yes;❑ No L�1" FHp'Np`= Yes ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: c tNo septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest welL________________Dis#ante from foundation--------------------Material......,_.__..-------.•---------••---•••-•- t• Ta - Liquid depth ..--- --...Size__....-----•-- - q 1? •------•--------------• No. of compartments____________ __ ---------- - om Ispo al teld: Distance from nearest well-- Distance of reach line----------------------------- Type ation . - - _.Width ofttrench est lot line----------------- 1 Number of lines---------------- 9Total length = Type of filter mat L_; ------------Depth of filter material.---.-:•---__------`- � g i Seepa a Pit: Distance to neareell_ '- Distant f o fo dation._ �----•.Distance to nearest lot iine.l.�..---•- Linin material_. e&_size: --.Depth----- ----•- Number of pits__.-___ _ __ _ 9 Cesspool: Distance from nearest well_ ___________Distance from foundation_-_._____.__.____._.Lining material---------_----------------- ---------- ___-_--- •----- ----.De th-------------•---------•--------------------------- Liquid Capacity. gals. � ❑ - Size: Diameter------------•------------------ p . . _ Distance from nearestbuilding.---•-----------..................... Privy: Distance from nearest well________________________ Distance to nearest lot line--------- --------------•---- --- ------------••--------•---•------- + -•-----•••----• •--. �.. -- •-----�-�-- Remodeling and/or repairing (describe):_ ---_-- -- p -----• -------- ...... - - { --•-------•-•------•-•--••-----•------------------- 9fat Y-------= - -• I herthat I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinance �anQdsand re htions of the San Joaquin Local Health District. 4 . !J(Signed} -- f - er and/or Contractor] 6--e (Title} -- �- ton of system in rely fi__-a--- BY: =-------- -- (Plot plan, showing size of lot, location y tion to wells, build' s, etc., can be placed on reverse side). FOR D PART T USE ONLY DATE - ._ s APPLICATION ACCEPTED BY____._� -__ :__ - - _ DATE----•�' -a?_ ------------------•---•-••---------•-- REVIEWEDBY------------------------------•------- ----------- -- ------------- ----------- BUILDING PERMIT ISSUED------------- ------------- ------------•------ Altera 'o s an /or recommendations:. -----------•-•-- = ---•-----•-••-- Z . Via• �J '--- ________________________________________________________________ FINAL INSPECTION BY:.._�_ ---------------------------- ----- ------------ -- Date------- -------------------•--•-----------••---...-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sooth American Street,, 300 West Oak STreet 144 sycanfore Street 405 Well 9th Street Lodi,CalifornlaN Manteca,California Tracy,California l Stockton,California , e ES 9 REVISED 8•99 2M a-61 ATLAS