9619 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .____.. (Complete in Duplicate) Date Issued _____ Application is hereby made'to,the San Joaquin Local Health District fora permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS�AND LOCATION-_--- -, . � A)/_�------0�,:----------------ff�� -------------- - M t t � ZZ Owner's Name-41---I-1-s'-'�----- 1 -44--_ �.(,)` Q�1 Phone I7 AddressllQ ' .Crr__'_ !_� _+~k'�_ �-------•------- •-----------------------------------•--------------------------------------- ----------------- r , - Phon __ � Contractors Name----- f` °-�`S' �7 w ---- ---------------- .: Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Number of bedrooms __-:Number of baths _-�___ Lot_sizei-T------�----�-•��-�- •-----------•-- Water Supply: Public''system [Community system.'[] Private-E] Depth to Wate'r'Table o{t. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay [j Adobe Hardpan ❑ Previous Application Made: Yes [I No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se iq_T k- -Distance from-nearesr well------------------Distance from foundation____________________Material--______ _-_-_-____.___----________.___--_____. !Capaci rf��n_ [ P V Size- nce from foundation uid de th :Y -iNo.`of. com artments_ q P. Disposal Field: Distance from nearest well_ f� �-Dista I�---:_---.Distance to nI I earest lot line----------- �g]� q I _ _?Length of each line------- -Width of treri lig ------- ------- Nu ebof filter matenaL -- -- - E 4 I t... d4j, ' YP ,_ 5.--_Depth of filter material---- -- -----------Total length-- - - --------.-- .� = ---.. .1 f 1 6 l Seep- e Pit: Distance to nearest-well_!4-0-l� -.__y_Distarce rom foundation__-�__1_._..Distance to nearest lot line___ ___ _____._ P 3 f -------- Number of pits._ .-�_---------------Lining material__ _ c - ___---Size: Diameter---owl_r�-----------Dapth__.__2_�--_---,- t. Cesspool: Distance from nearest well________________.Distance,{rom oundat.ion_— � _---rt:L:ining-material►_++_--_____.---__-__---- _____._. �l Size: Diameter r.--I a --- Depth- -. - --------------------Liquid Capatty gals. ❑ Di`stan'ce frbm ne�ar t- luf din - " Privy: Distance from nearest well:-- ---- ------------------------ ----------- ----------•-- g A '*�`+. : . ----- -- - � f ❑ i Distance to neare lot line_,, -_---=.---. h- .._ `C Remodeling and/or repairing-[describer-------------- I------ = r--- s ` f------------ ------ - ------------------------------------- - ---- = ---------- : t. = -`0-------------------------=-•-------•------------------•--------- - ---------------- •- = I-` -j i-------- � -�----�------- ----�-------'a`-x �w------------------------------- ----------------------------- -----•------------------ ----------------- _ I hereby cee'fy that I have repared this application and._�hat theme ork:will be done in accordance with San Joaquin County ordinances, Sta�e} ws, and rule and"rregu s.,.of„the,San.Joaquin Local,-Healtli District. (Signed) : l �x� : �� ;:_ �._ • � Cont r) - Tp yj By:------------------- ----------------------------------------------------- (Plot plan, showing size of lot, location of system in dation to wells, buildings, etc., can be placed on reverse side). f R DEPARTMENT USE ONLY APPLICATION ACCEPTED B u ` ----------------------------------------------------- DATE-------- t ----------------------- REVIEWED BY-----------t----------- ---------------------------- = DATE- - --- BUILDINGPERMIT ISSUED----- `----------------------------------------------------------------------------------------- DATE-------&.-------- -------- ---,--- --- -------------- Al#erstions and/or and/or�reoommendatons:----�-'n�-vir-------------------' --------------------------------------_..--------------------•---•----•-•------... .------------------- r------ / ....... - f --- ------------- 'Z®.-_S_-�--------- � � f---�/'�— Q` � f -�� 5� 'C�fa ! --- ------------------- ------------------------------------------------------------------------------------------ ---------------=------------------ : : • - ---------- �- ------------------_------ --------- -=----------------------=----------- ,3 FINAL INSPECTION-BY:. =-=------=-------- . Date--- ------ �1 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 , Revised 1.57 F.P.CO.