5073 - Laserfiche WebLink

Home Browse Search

- ° 7-3 APPLICATION FOR SANITATION PERMIT Permit No_ ___________ ___ (Complete in Duplicate) Date Issuedvy'�, .. t l og Applica+ion is hereby made to the San-Joaquin Local Health District for a per it co truct a � insta 'the work herein scribed. This application is made in complia c 'th countOrdinance 549. 0 0 ?�9 3 —S' f-f'4lL s�"�i.�N� - JOB ADDRESS A [ LOCATIO -------- ------ ---- ! w ... Phone 1 �.E,f. Owner s me --- t �,�� k -''?� Address_ ----------- ---- Contractor's Name- ------------------------------------ phone ..I:� -- - ---• - _.,_ F Installation will serve: (Residence Apartment House ❑ Commercial ❑ Traier Court ❑ Mat ❑ Other Number of living units: __�__� (\lumber of bedrooms ./VF-- Number of at... -- --- Lot size -- - pp��----- -----`-�-- - ----•------------- : Publics stem ❑ Community system•❑ Private Depth ater Table -------- ft. r; Water Supply: Y Character of soil to aFdepth}of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ C ! Previous Application Made: Yes ❑ No New Construction: Yes No ❑ I r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ubli sewer i available within 200 feet] ' ----{--_.- * Capacity_.._ _ '---Li u�d d +h No. of compartments_.-,-_.--- -t--__._�Siz -- q - istance from foundati n__#-- _. _ (stance to nearest lot ine. Dispos Field: Distance from nearest weleibopip -.-----= ' �_ mr Number of lines___________ _ _ Length of each line___- idth of trench__________ ___ !F Type of filter materii]epth of filter material-------- length_____-__. _ ----------------- or - ------ p } Seepage Pit-` Distance to nearest well,_._________-___---__Distance from foundation-------------------- to nearest lot line----____-____-_:_ ❑ Number of pits-------------- -----Lining material---------------------- Size: Diameter Depth W ,�. { Cesspool: Distance from nearest welL_A______________Distance from foundation______-_____._=___.Lining material_._______:____--------------- els. ~' Size: Diameter---------------------------- -Liquid Capacity-------------- Depth _ g )] Distance from nearest well--------------------------------- F Distance from nearest building-:_--:_----------- •-------------------- Priv _ _ .� .,. -- _ -------•--------------- Y' -fir ------------------------ Distance ta_„ia.eare�taot; 3ne.-,:- F�.-----`:-_�----------------- Remodeling and/or repairing (describe)-------------------------- --------------------------••--•-•- ---36••--•--_-----•-------- -------------------------------------- . ---•---------------------------------•--•------- -----•-------------------- __________________________________________ _ 1 - -- -------- ------ -••--- -- • --- q ty I hereby certify that I have prepared this application and that the work will be done in.accordance with San oa um oun ordinances, State laws, and rules and regulations o the San Joaquin Local Health District. ---_----------------------------(Owner and/or Contractor). - --- (Signed) ---- --- -------- -- I r -- ---- - (Title) a (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , s FOR DEPARTMENT USE ONLY t ---------------------- APPLICATION ACCEPTED BY . ` DATE ---- ----------�� REVIEWED BY----------------- = ------------------------- DATE_- -------------------------------------------- 1 BUILDING PERMIT ISSUED-------------- ' -----------------•----- --- ---------------- -------------• DATE------- --- s Alterations and/or recommendations_________________________ _ :- ----•-------- -----------•------------------------------------------ ---- ----------- ----•----------•--------------•-------------------------' ----- -------- . - -..----------- ------------------------------------- ;------------------•------------------ ;i ----•--------•-------- - --- ----• -------------.- 9 ------- --•-------------------- ------------------------------------------------- ------------------------------------------ ------ ------ ------ ------------------------ ----•--------------- Id / �1 FINAL INSPECTION BY---------- ----------- --------- ----------------------•- -----• Date---------- ----- -------------------------------------- SAN -------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT - � 130 South American Street 300 West Oak Street, - 132 Sycamore Street 814 North "C" Street Stockton, California -•--ti. _:4. Lodi, California Manteca, California Tracy, California - ES---9-2M Rev'ssed W-2100 �°