10261 - Laserfiche WebLink

Home Browse Search

7,j ' APPLICATION FOR SANITATION PERMIT Permit No. _-l.p._Z V% a r (Complete in Duplicate),, !0 3 Date Issued / S Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 9. r JOB ADDRESS AND ... -'._----.--_____y ----- P �T .A,... Owner's Name 4 `u -------- .. r�T .,5= ---------- Phone r --------- Address---- = !�r� -----•----------•-------•-----•-•------------•--------------- -•---- / Contractor's Name-•------------/2D_ ------ -----------------•---------•---- one Installation will serve: ,Residence l Apartment House ❑ Commercial ❑ Trailer•-Court b. . .T t ❑ Motel [I Of er Number of living units: __.I___ Number of bedrooms 3:-_ 'Number of baths _' Lot size ____ 0•_X--_ -�`----• :-- -. Water Supply: Public system ❑ Community system ❑ "Privatgl epth to Water Table Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam I] --Clay Loarn ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes UQ/No LI ❑ New Construction: Yes to ❑ FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: u (No septic tank or'cesspool permitted if public sewer-is^available within 200 feet.) Septic �Tank: Distance from nearesf we4_51---_---__Distance from foundation_-/_Q_____=._.Material___ LN' No. of compartments------,�„--------------Size___ ` ---X - _Liquid depth---��a.�-------.CapacitY---- ------ 4;�, Disposal F' Distance from nearest well... Q._r_-Distance from foundation_fb__"?-----Distance to nearest lot line_14-11, . ber of lines--- .Leng+koff each lilateri 2X-- ,---------.Width of trench__�'�___`�`!__._V.-___-__--� Type of filter material__Y4�_�___._--_ aI---1-�-- =-----Total length----./-.S ------------- epage P Distance to nearest well___'�.w-_�'1 p___ '/Distance`from foundation_ a" ' - ,�_ _ ,._.__.Distance to nearest lot line-,�________._� e' Number of pits_-_-__z_- C '/ Lining: Diameter---- -- ---------Depth--- ---�--_------------ i � r - Cess ool: Distance from nearest well_______,'_-__._IDistance from foundation-------------- -----Lining material________.-_-__.____._ T p _Liquid Capacity----------------------------gals. ❑ Size: Diameter--------= --------=---------' -Depth----------------------------------------------------- ------- --------=------- rivy: Distance from nearest wefl__°__`� ------------------------------------Distance–from nearest building.--------:-----------=•-------- ❑ Distance to nearest lot line -------- --------------------------------------------------------------------------------.-- - Remodeling and/or repairing {describe):_------------'=--- -)-- -- - ------------ ------- _ -------------- ----• -------- -- -----•------------------------------------=--------------------------------------------- -------------- ---------------------------------------------------------------------- I hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . (Signed)------------ ( caner a r C ac ------------- __ By:-------- - == (T;+le} --- - - -- n a on r or - - ----- - - ----------------------------- (Plo+ plan, showing i of lot,"ocation of system in.relation to wells, s etc., can be placed an reverse side}. FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY------- - DATE----- C� ' ------------------------------------ --------- -------- REVIEWED BY --------------------- ---- DATE ' - -- ---- BUILDING PERMIT ISSUED--•--=--------------`--------- -- ------ DATE- -------------- Aaerations and/or recommendations:--------------------------------- ---------------------•- -------------------------•----- r -------------------------- - ------------ ----------------- ---------------- ------------•------------------ -------- ------------- -------------------------- FINAL INSPECTION BY:----- =' --------------------- Date------. •---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M Revises 1.57 F.P.CO.