10906 - Laserfiche WebLink

Home Browse Search

Opp Permit No. .J- -- ---�-•--- APPLICATION FOR SANITATION PERMIT f (Complete in Duplicate) �j P ) Date Issued d install the work herein described. -- Application is hereby made to the San Joaquin Local Health Districtfor o a permit to construct an Thisapplicationis made in compliance with County Ordinance No. M1 --� . ------- - ---- ---------------_-- JOB ADDRESS AND LOCPTION s ----- Phone- �, Owner's Name-------------------- ------ � x� =�� — -----------•----------------------------- .--- Address------------------------ 71 on Contractor's Name____________ _______• - ------ Other ❑ � Installation will serve: Residence Apartment House [_1 Commercial Commercial ❑ Trailer Court ❑ I]..07 e - Number of baths _�---- Lot size ____- __. - �C ----------------------- Number of living units: _ ___-_ Number of bedrooms _ Private ❑ Depth to Water Table __4bft. Water Supply: Public system Community system El1 ClayAdobe Hardpan ❑ >� Character of soil to a depth oee+: Sand Gravel 1-1SandyLoam ❑ Clay Lam 0 Yes El �! : Yes ❑ N Previous Application Madeo New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) Wepic, nk , Distance from nearest well_-______--_____Distance from foundation__________ Capaci#y._________________"____ No. of compartments----- --------------------Size---------------- Liquid depth P Dy----____Distance to nearest��line./� le- o-------- I Disp l f ell: Distance from nearest well_A/—/ Distance from foundationWidth of trench___ ____- ------ ! `'� Number of lines------------ ---�---e---------- -Length of each line �1------ � Type of filter material-----r�-C-�--Dep#h of filter ma#erial----.��-----r--Total length-------f---�------------------------ Distance from foundation_c ,[�_..____..Distance to nearest lot line___ ----� I Seepa Pit: Distance to nearest well--W1_ .-- -- ----.Depth__.._ - - ------------- Number of pits___-_ __---__-_Lining material-____--� CSize: Diameter---_ __ Cesspool: Distance from nearest well-----------------Distance from foundation____"_______.____-.Lining material______-___-___----------------gals. ----De th----------------------------------------"--------- -Liquid Capacity ❑ Size: Diameter_---_----�-------- ------ - p ------- --- --------"-Distance from nearest building------_------------------------------- Privy: "- I Distance from nearest well----------------------- ----- ❑ Distance to_nearest lot line------------------------------------------------- Remodeling .and/or repairing d scribe : y -- ----- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun#y ordinances, State laws, an ules and g +ionscof the San Joaquin Local Health District. - --- ------- --------------`-'-`�-" �!C - 1 _-.-. (Owner and/or Contractor (Signed)----------------- - - -� ------- By: �d (Title) .F � - --------- -- BY (plot plan, showing size of lot, location of system in rela#ion to we s uildings, etc., can be placed on reverse si e. F. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ DATE-----�-----19-----S_2- --------------------------- - ------ DATE----------------------------------------------------------- -- - -------------------- REVIEWED BY-------------=------------------------------- -------------------------------- - - ---------------- ---------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------- ----------------•------------------------------------------- Alterations and/or recommend ations:_______________________ ----------•----- - �7 - - --- --- -- --------------- - ----------------------- --------- -- } ----------- ----- - - ---- " Date---- FINAL INSPECTION BY:.____ ---.--" --- --- •- �- � ?- �-- ------------------------ ---- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California E5-4-2M Revised 1-57 P.P•Co•