6691 - Laserfiche WebLink

Home Browse Search

x / APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _9y . " i Applica{ion is hereby made to the Sari 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. a f JOB ADDRESS AND.LOCATION------------------- ----- ---- ------ Owner's Name-l__Z2,1""±z-l� - Phone Address----�! - ------ -------- .... - -••--------- ----------- -------- -------------••------------------------- Confiractor's Name Phone. r ----- Installation will serve:' Residence Apartment House ❑ Commercial ❑ Trailer Court ❑- Motel ❑ Other ❑ Number of living units: /-__ Number of bedrooms _4-2-. Number of baths /___ Lot size - `'r�_/ / --------------------------- Water Supply: Public system wolcommunity system ❑ Private ❑ Depth to Water TablW ft. Character of soil to a'dep+h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam .❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [�lew Construction: Yes ❑ No �_ ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted�if public sewer is available within 200 feet.) I epti Tank: Distance from nearest well _______________Distance from foundation------------- ------Material--------------------------------------------- ._.. No. of compartmems------------- --------•----Size------.----�----------------Liquid,depth-----------------------_Capacity------ ---------------- D•spos ield: Distance from nearest well------------------Distance-from foundation--------._._;--_..Distance to nearest lot line_-________--.-__ Number of lines---------------------------------__Length of each line----------------------:------.Width of trench----------------------------------. Type of filter material____.___----------------Depth of filter material___.__,- - -_._Total length------------------------.-_-_________--__ d _ 3 d Seepage .it: Distance to,nearest well��?'f:'�1---Distance f�roTfi foul Distance to nearest lot Linin ma eralce-s-1 _ - Dim eter-- -- - ---------Dept'n-.-._.1-�------------------ Number of pits.__.__,F--------- - g - �,. Cesspool: Distance from nearest well-----------------Dfsfiaa a from foundation.;_._ ...... ___._.Lining material_._.___--.._ ------------------ Size: Diameter-----F---------------------------------Depth-------------------------------=--- - ------------Liquid Capacity----------------------------gals. ❑ t ---___Distance from knearest building Privy: Distance from nearest well------------------------------------- - -- ❑ Distance to nearest' lot line.__---_----_ ---- ,7e' f ,3 Remodeling and/or repairing (describe):------------------------- ------•-----------.. -------------------------------------------------- -• ---:.._-----------•---- ' -------------------------------------------------------•------•------------------------•-------.....•----------------•---------- ---•---------------------•-••-----------•---------•----•--•---------------------•------------------•------------ ------------------------------- --------- -- - ------------------ ------------------------------------•-•- -------•---•--------------------------•------------------- -------••----: -------------•------_--------- I hereby certify the+ l have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, ate laws, and rules and regulations of San Joe uin Local Healt Di trict. (Si ned _W�,A � �.__(O iiiand/or Contract r) 9By----------------------••---------------- = = Title -------------------- (Plot plan, showing size of lot, Iota+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIQN ACCEPTED BY ----------- -------------------------------------------------- = DATEC� REVIEWEDBY- ------------------- ------------------------------------- ----------------------- ----- DATE_--------`--�----------------------------------------- BUILDINGPERMIT ISSUED-------------- ------- - ---- - -- ------------------- ------------------------------------- DATE ` -------------------------- Alterations and/or recommendations----------------- -- -----------------------------`•------ ----------------•-•------•• -------•-44�--------------------- ------------------------------------------- --- --------------------------------------------- - - -- ---------------------------------------•--- -----------•--------------------------------------------------------------------------------------- --------------- ---------- -------------- ------- -- - -------------------------------------------------- FINAL INSPECTION BY:_`_��__ �------------------------------ 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--9-2M 14-46 ATWDCD 12.54