14118 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------- ----- ----- ` APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------------ (Complete in Duplicate) Date Issued - -------------------------------------------------------- L This Permit Expires 1 Year From 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 LO TIO �� _ ............................................................... .. Owner's Name .e :---------- -------------------------------------------... Phone. ••.... ......•---•-------. ----------------- Address ---------------------------------------------------------------------------------- ............-...............................I---------- Contractor's Name------•A; '~JY Phone Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __/___ Number of bedrooms J_ Number of baths. ___ LotsizeIft-- ----------------------------- Water Supply: Public system�❑ Community system'E) Private �epth to Water Table . . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑f Clay Loam ❑ Clay ❑ Adobe @!r'�Hardpan ❑ Previous Application Made: (If yes,date____________________} No New Construction: Yes ❑ No M0"1FHA/VA: Yes ® 'No ❑ TYPE OF INST-ALLA TIO AND 'SPECIFICATIONS: (No septic tank or c se Spool permitted.if_Pu4bG sewer is available within 200;-Feet.) Sri tic,Tank- Distance from nearest well___----e-____--Distance from t mfounFdation _.-�____� _ _ Mateial_� ...................................... 6isp l _ I ` Liquid r ? Capacity.......................... foundation_ - p _Distar4ceo nearest lot line..4�: ....Dis osal Field: Distance from nearest well � Distance fro Number of lines___- en th of'each line__ �_.... 9 Width of trench ---------------------- Type of filter material Depth of filter material../r_' ________Total length-------;?�7-------------------------- Seepage ---____________________Seepage Pit: Distance to nearest well'%___-________________Distance from}foundation....................Distance;to nearest lot line---------------_ ❑ Number s - n9ml,, f .� Diameter---' ---- _ "teDrieaplth................................ ------------------------••-•---------Cesspool: Dstne from nearest well;' al_._ Dstnceom foundation -Lining N 0 ❑ Size: Diameter---------------------"--e!---------Depth-=t-----'�-----'----------------------------------Liquid Capacity---------------•---•---•--•-gals. we Privy: Distance from nearest well-_0-__._________,'_________f�--T________�:._Distance from nearest building-------------------------------- ❑ Distance to nearest lot line-: ------- =,.: Remodeling and/or rep firing_(describe):-----"`_--- = ---- 6 ................. ` r _ __ ------------------------- � .................. -- ---------•---------------------------------------••----------•-•- --------.- I 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 rut s and regulati s of the San Joaquin Local Health District. s {Signed} -------------------•---------�-----------------•-•-•--------_-------•--•---•-- or Contractor) BY: --------------------------••-••----. ------------------------- ----------------------------------------(Tiiifle)..... -----•------------------------- .. (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------ =_----------------------------------------------------------- DATE.... -=--------- .. REVIEWEDBY--------------.---------------•--------------------------=------------------------------------------------------------------ DATE------------•-----------•------= i BUILDING PERMIT ISSUED------------------------------------------------------------- DATE--------....--------------------------------- -- ...•-- Aherations and/or recommendations:--- .-f l-'-- - ------- -�SIP__1.!� x i1•----,r...... -------[-A>-lo - ----------------------- -�- `E; .t ±a..---..9-.e .# a __....ZL...... -•-------•iN. _ 2.�.T. _i�1--o------------- -------- FINALINSPECTION BY------------------------------------------- ---------• -------- Date----------------------------•---•---•---•-------------------- ---------------- SAN,JOAQUIN LOCAL HEALTH DISTRICT- 130 South American Strut ~ 300`Wost Oak Street `: +�Q �.i 24 Sycamore Strait 205 Wort 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISEo 6-59 pM 5-61 ATLAS f