8701 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the Son'Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance ith County Ordinance No, 549. L' ( R JOB ADDRESS ANb}LOCATION__-- -- r r. -`-- ' ---------------- -<:K --- - 1 �.1 -- -------------�-------- -- ---- -- ------------------- ------- ------------------- Owner's Name Address.------ - ®-- ----- hne--------------------- •------- - --- Contractor's Name- ------- --------- } ------- ------------------------------------------ ______ __ Installation will serve: �Residen -� ---- Phone ------- ❑ Apartment House ❑ -Commercial [] Trailer Court ❑ Motel Number of living units: - Number of bedrooms _ ❑. Other (� --- � - 77-Number of baths _--_---- Lot size ------=�-- ________ __ _______ . Water Supply: Public system ❑ Co' mmuFiit s stem Y Y ❑ Private Depth to Water Table ; Character of soil to a�depth of 3 feet: Sand [] Gravel. Sandy Loam ❑ ClayLoam a r Previous Application Made: Yes E] No New Construction: Yes ' No ❑ Clay ❑ Adore❑ . Hardpan E]TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ FHA/VA: Yes [I No (No septic tank or'cesspool permitted if public sewer is available within 200feet.J f"" e from nearest well_� 1.�1 '{ Distance fro found tion_-._-f - ------------------ Disposal Field: Distant t Liquid depth_--------- - apacity-. _�_p-Ca-__ T p e from nearest well -- �"Distance from foundation----/00 ,•----Distance to nearest lot line- 0 N'rriber of lines------------- g -.---- -------.----_- Length of each line--__----7_- - -__- Width of trench-- Type of filter ma#erial___-J7- -Depth of filter material_.-.-X- � -----_ Total length--------- ----- Seepage Pit: Distance to nearest well--__--__-`-_--_---!Distance from foundation----------------1--------------------- Distance to nearest lot lin e--__--,..--•----- ❑ ' h�mber of pits-�--------------- ----Linin material_--------_-,- g ----------Size: Diameter`--- -------- ""De'fn- r r Cesspool: ------ ❑p Distance from nearest well_-- __Distance from foundation---------------------Lining material-_---------------_---_ Size: Diameter_ - -----Depth--------------- Privy: - f - ------ -w --- - ---Liquid CapacifY------------------------- gals. T s -,. r-_ Wer Distance from nearest well__--_-:-- ------------ - -- - --Distance from nearest buildin yt ❑ Distance-to nearest lot line-------- g j -------------------- --- --- : Remodeling and/or 1 K, escribe):_--- !/ ------ ----- -- + - ------- ---- -..._-- i nA � -----_._ - �- --------"--- ! i ---- I hereby certify that I have prepared this application-and'fhet fhe'work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of he San Joaquin Local Health District. I Sr ned � ( ig ). �. ---- - - { 0 —1----------------------- ------------(Owner and/or Contractor) y (Title)----------------------------------------------------- (Plot plan, showing size of lot, location of s `stem in.relafion to wells, buildings,etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-'--, - 1--t_---_ REVIEWED BY----------- i DATE------------•---------- ------------------------------------------------------ BUILDING - r PERMIT ISSUED-------------- ------------------- ---------------------------'' 1' 1 � - DATE---------___----_- ---------- ----------------- �-= ------ --- -- DATE------------------ Alterations and/or recommendations:E __�--*':-§--__---_____ # - =- ------------------------ -------------------------------- ------------- == + r - II: i ----------------6------------------------••---•---------------•--------------------------------------- - . ------ --- ------------------------ -•-------- r f �.. ------------------------------------------------------•------------------------------- ------------------•------------ ----- --------------- " ---------------------------------------------------•- FINAL INSPECTION BY------------------`------------ �^- �--------------------------------------------- - _.. .- Date--------- __X_W ----------- SAN -� ` F 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-9-2119 , Revised 1-57 F.P.M