4357 - Laserfiche WebLink

Home Browse Search

�— Permit No `3` APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued o construct and install the work hdescrib p�pplication is hereby made to the San Joaquin Local Health District for a permit ter 'n Td. This application is made in compliance with County Ordinance No. 549. e JOB ADDRESS AND 0CAT IONA - ----- ---------------------- ---------------------- phone-------------------------------------- Owner's -- ------------------------------ Owner s Name -------x_ ____________ ------------------ _____________ ______._____________ __________________________________ _ PhoneAddress - --Com_ ---�------ - --- - --- Motel ❑ Other I] ;4_ �_IX Contractor's Name________ -�=------- - '---- Commercial ❑ Trailer Court ❑ Installation will serve: Residence Apartment House ❑ ---- umber of bedrooms ____'___ Number of baths }o Wafer _}'--�ft Number of living units: ________ IJ • Communi# system ❑ Private ® DepthHardpan Water Supply: Public system ❑ y y Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ El of soil to a depth of 3 feet: Sand ❑ No F1Previous Application Made: Yes ❑ No ® New Construction-, Yes TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) ( -_Distance from foundation____h------- .Material. - ---- ---- -- --Li --- de th_ _ _- Capacity__1_ s2A 7. \ Septic Tank: Distance from nearest well__.�a - - q P --- --- ------- P Size---------------- ® No. of com artments_____a� _ Distance to nearest lot li e---- _______ �E Width of #rench__r-_ __�-,-- - Disposal Field: . Distance from nearest well.�dO DLength oftance reach I ne om ati� �� ® Number of lines__0,-,A ----------- otal length-------�_ p- [--- ----------------- �r�We th of filter material__ Type of filter material- _ G- --- - P r material from Size: Diameter --------------------.Depth------------------------------ SeepagePit: Distance #a nearest well from foundation________,___.___--..Distance #o nearest lot ine_______-________ ❑ Number of pits------------------- --L Lining ma Distance from nearest wel4__--------------Distance from foundation--_.__---____------.Lining materia-_---- ---___-_-____-___`als. Cesspool: --- Depth--------------------------------------------------- Size: -- ------ __ __Liqu+d Capacity g j.„s � a � �.— - ❑ Size: Diameter------------------ -- --- � --------------------- ---- ------•. Distance from nearest building -------------------------- Distance from nearest we __ ---- - - - �--�- Privy: - --------------------- -------------- -- ❑ Distance to nearest lot ine___________________ ------------------------------ - r, ---------------- Remodeling and/or repairing (describa):--------------------------------------- --------------- ------------ ------------------------------------------------ --------------------- ------- .A ' --- -- --- ��. �.�-------- ---------- - � Q�� ` '� = -------- --------------- "-------- --�------------------- � --- .---��'____�------ _ ----------------- G -.1--I�_-�------- .. ! herebycertifi that I ave pr pared this applicatie San Joaquin Local kHealth eDi District. ordinances, accordance with San Joaquin County ordinances, State laws, an rules and regulations of t � Joaquin (8 door Contractor) wow ---------------- (Signed) ''r' (Titlep_ -- ----------- rv --------------------------- $Y= - buildings, etc., can be laced on reverse side). (Plot plan, showing size of lot, location 'of system in relation to wells, FOR DEPARTMENT USE ONLY L� --------------------- ---------------------------- ----------- DATE--------------- ------�''---------- ----- - ---- APPLICATION ---7---- APPLICATION ACCEPTED BY.... -- ----- -- ---- ------ - ---- -- DAT ------------------------------------------------------------ ---------------- ------ ----------------------•------------ ----------------------------------------------------- ---------- ------ - - --------------- ------ --- DATE---- ------------------------------------------------------- REVIEWED BY------------------------------------------------- ------ - --- -- - BUILDINGPERMIT ISSUED---------------------------------------------- -- ----------------------------------------------------------------- Alterations and/or recommendations------------- --------- -------------------- ------------------------------------------------ ----- -- --------- --------- ---------- _ Date ----- -------- ---------------------- FINAL INSPECTION BY: ---------- -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C' Street 132 Sycamore Street Tracy, California 300 West Oak Street Manteca, California l30 South American Street nodi, California Stockton, California ES-9-2M 8-51 Revised W-2100