11508 - Laserfiche WebLink

Home Browse Search

6 41 APPLICATION FOR SANITATION PERMIT Permit No. ....1_ 5 D S (Complete in Duplicate), _ ��- �^ --- -Date Issued ____- 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. 549. JOB ADDRESS AND �ATIONt--i�1_62'r-_ - - --��---------------------------------c------------------------------------_ �{ -----i---------------------- Owner's Name t "J--- - --1•---lfiQ-` 1------•-----------•------------------ ----- Phone--�!`P- Address----------- Z' --------- ------------ •-@t---- _a. 3 I Contractor's Name------------- ----------------------- Phone-------•--------------------------- Installation will serve: Residence RI Apartment House Commercial Trailer Court Motel Other Number of living units: ____I___ Number of bedrooms _Z._ Number of baths _�----- Lot size _�Q____=?�____)_��___________________________ n Water Supply: Public system K Community system ❑ Private'[-] Depth to Water Table ________ ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[I Hardpan ❑ Previous Application Made: Yes ❑ No XL New Construction: Yes ❑ No N FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance.from nearest well_________________Distance from foundation--------------------Material------------.----------------------_____________- ❑ Nc''of compartments------------ii-�-----------`Size---- = -------n_--n-Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well._.tV_ ' '.+Distance from foundatig�____i<_�}_____.___.Distance to nearest lot line____`-��_157- 5g Number of lines___._________ `#.____ _______Length of each line______21 Q__'.______ Width of trench.----Z,- -� ti( i - . - Type of filter material____ '-_ _____Depth of filter•matenaL______(�__________Total length__________ff 0------------------i I ' Seepage �it: cL Distance to nearest well____ __ _8'1�. __Distance om foundation----_�_Q_____-_..Distance to nearest lot line__.______ i Number of its.___;_ I-----Linin material_�----Size: Diameter___36-----------Depth......2s___________________ ool: Distance from nearest well________________Distance from foundation--------------------Lining material-______-_------- ---------_________ ❑ Size: Diameter---------------------------------------Dept h----------------------------------------------------Liquid Capacity----------- - -------gals. Privy: Distance from nearest well_______ _.._______.__________Distance from nearest building------------------------------------------ ❑ Distance to nearest fot line--------- ------------------------------------------------------ ----------------------------- ------------------------------------------ Remodeling and/or repairing (describe)------------------------------------ i ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------•---.......-..•-------•--------------------•---------•-------------------------------------------------- ------------------------------------ -----------------------------------•--------------------------------------------------- ---------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stateelaws re ations of the San Joaquin Local Health District. (Signed)-__z, ;�ru;lesd ---------_ - .------------------.(Owner and/or Contractor) .._f By:----------------------•-- ----------------------------------------------------- -------------------------{Title)--------------------------------------- ------------- (Plot plan, showing size of lot, location of system in .relation to wells, buildings, etc., can be placed on reverse side). -FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY------- = } = z =--------- DATE = i . ., REVIEWED BY .'^ ----i------ DATE----------- + - -•--•----------------------- ----------- BUILDING PERMIT ISSUED-------------------------------- --------- ---------------------- DATE------ N----- -------------------------------------------- Alterations and/or recommendations:- ------ -- - ------- t - - .y( --_ -Y4_'--Pte •=_`-12_ _ ; j�� ______ __ __ _____ _ _- _-- ___ _._ r ye _. ___.__.__ INAL INSPECTION BY--------------- r------r--'--- A------ ------------ Date----------------------------- -------------------------------------------------- SAN --V-----d----------------------------------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 ES-9-21x1 Revised 1-57 F.P.CO.