10275 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This applicatiori is.made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- ... t1A__0Z-�-----IV,--- 6--a-� idI-----f55;ff6_--------- ----------------------------------- Owner's ----------------------•----_Owner's Name---------:`------------------------------------------------------------------------------ Phone-------------------- ---=-------•- ---- Address------------------- -•• 45i7-/ / ------ g5-:;77 ----------- --- +^ one Contractor's Name --------- ... Ph - J - , , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 1 Other ❑ 1 ' 1 Number of living units:._ Numbereof"b�-edrooms � Number of baths Lot size _________-_- --'� - R---- Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table ,51C%ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel '❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,W Hardpan ❑ , 'Previous Application Made: Yes ❑ No [y New Construction: Yes ❑ No FHA/VA: Yes ❑ Nok TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) ilk Distance from nearest well ___------------- Distance from foundatiLOiquid depth _Material --------------------------------------- Septic_' Capacity �� i No. of compartments_-___ .___ ---- from foundation____________ _____Distance to nearest lot line___________ --- ---------- Size------ ------•--- Dispos l, Field: Distance from nearest well ------ ________ Distance r ;a", 14Y Nur6er of lines ------------------------------- ----- Length of each line ---------------- -------------Width of trench ------------------------------------ Type of filter material____ ____ _____________Depth of filter material_=__- __ ___Total length_____ _.,,______________------'- See a Pit: Distance to nearest well____!'VI------Distance m four%dation______#�_.Diste�n�e to nearest lot line_.____-. 0 ' Number of pits ---- --------- Lining material-----�_----Size: Diameter -,-.-------------Depth.-.<--------- Cesspool: Distance from nearest well______.,.__.___' Distance from foundation__________________Lin'sng material-_.,__-._____________________-._____. F1 Size: Diameter----- -----------------------= -Death - ---- •--------------------- ----- Liquid Capacity gals. _ T:Distance'from 'nearest building ----- --------------------' PrivDistance fro manea'rest well _-,!... ...------------ - g`_-___ Y �le � : *- r,4 3 0 "est lot Ime_ �'.' m .. .a .. - -------------------- ------------------ Remodeiin and/or repairing descr is ante o near g / P g ( ibe] iU/S-!,e'er% - st - --_- F__ __ _ __ __ ______ _ __ _ __ _�__ ____ _ _-_ __ -------------------------------- ----------- ______-_-__ _ _ ___ __________. _ ____ ________________a___-__ ___._._________________-__-_ r. ----------------- r ------------ ---=-- . ' _ - ,------- _ ___ ___ --------- t� "-fid T_ pp - r -.. u k hereby certify that l have prepared this application that the work will be done in accordance with San Joaquin County. ordinances, State laws, and rules an r�gulat' s of t a oaquin Locdl'Health ,District. Owner and/or Contractor} (Signe • • _�..-/ .e [Title}•-�-�--- ----- --- -- -- - -------=�"-- + By: -------- --------�( -�� =----------------' (Plot plan, showing -size of lot, location of system in relation to wells, bdildings, etc., can be placed on reverse side}. FOR DEPARTMENT 'USE ONLY ! ' APPLICATION ACCEPTED BY ----------------------- -- -----:-- ---- - ------ - ------------ -- •------------• DATE----------- --------------------------------- / . DATE -------k- -----------------------•------------------- - -- -- REVIEWED BY--- - -- ---- = - ------------- ------=----�-. -- BUILDING PERMIT ISSUED- -�- -=------------------------------------------- DATE - Alterations and/or recommendations:---:----=------------------------------ ---------------------------------•---------••--------•-------------- r -------- ------------------ --------------- ------------------------------------ --------------- - ,. !--------------.- ... Date-- ----- =_'::------------------------------------- FINAL INSPECTION BY:-.- = _-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 346 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California , ES -9-21A Revised 1-57 F.P.CO_