9222 - Laserfiche WebLink

Home Browse Search

l� Permit No. APPLICATION FOR SANITATION PERMIT / rl 4 (Complete in Duplicate) Date Issued v 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 incompliance with County Ordinance No. 549. ---- - JOB ADDRESS AN CA . 'ON---- -------- -- --- __eG f. ------------------------ - I �s ,r a A , Owner's Name `A •----------- -----�- �.�• :_ _ ,�= - -------- Phone d v Address " --- -- - •----------=----- '� ----. -- - -:-- Contractor's Name______....- � -- '_- ------------------- Prong--7--------------------A---------- •--------- -.---- ' . Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ otel. ❑ Other ❑ Number of living units: ---- Number of bedrooms Number of baths -_______ Lot size __ o ---------- .- -------- -- r•` � , / r Water Supply: Public system El system ❑ 'Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 o septic tank or cesspool permitted if public sewer is available within 200 feet.] S i Tan Distance from nearest well_________________Distance from foundation--------------------Material__._____-_-___.____._____________----.-.______- No. of compartments--------------------------Size----•------------------- ------Liquid depth---------------- ---------Capacity------------------- l I,Field: Distance from nearest well_________________Distance from foundation________-__________Distance to nearest lot line_._________._...- I Number of lines----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material------------------------Depth of fi' r material----------------------dotal length---.---------------------------/---------- ~' --_ m f undation__ ___ -.Dinh rre�.e �o nearest lof line__-_r_ __ �. Seepage ,PJ+:" Distance of to nitarest ell--/_-� material- reale f'----Size: Dieter �f Nu p - /// g .. m nearest well_________________Dis#ante from.foundatian_____.___________..Lining material_.______.__.________._________ ____. Cesspool: Distance fro ❑ Size: Diameters-------------------------------------Depth-----------------------------------------------------Liquid Capacity.---------------------------gals. \ Privy: Distance fromF�nearest welt____________________________________________--Distance from nearest building________--____.__-_____________--.-____-. Distance to nearest lot lire ---------A------ -----=---------- -=----------------------------------------------------------- ---------- g Remodeling and/or repairing {describe)----------- -------- ". ^--------------" � �.-- aI-,-t C�.:.-_.--------•--------� ----- ---- ----- -----------------------=-------••-•---�.-__-._ ------- ----------------------------------------------;------ -----------------------••--------------------------------- I ----------------------------•-----------•------------------------------------.-.--------------------------------- ----------------------------- ------- -- . - ------------------------------------ f I hereby ter ify fh + I have prrepare�his application and that the work will be done in accordance with San Joaquin County ordinances, Sta# aws,hrid�rule and re" I tions of the S �n Joaquin Local Health District. ned , f-_ ---------------=--------------- -- -- ---- ------ ----- "------------- ---- {4w4ar�and}!or Con+recto {Sig )----------- i i I3 rf (Title) '' ' f" "`'� ----------- Y• - i ------------------- {Plot plan, showing size of lot, location of system in,relati to welts, buildings, a ., can be pl7e� n reverse side]. FOR 15EPARTMENT USE ONLY APPLICATION ACCEPTED BY-- x Y_ --------------------------------------------------------------------------------- DATE__,_`�,�.-_.------------------------------------------- ---------------- ------ REVIEWEDBY----------------------------- ------------------- DATE , BUILDING PERMIT 15511ED -��-✓✓✓------------ ---------------------------------- DATE ------------------------------------- Alterationsand/or recommendations---------------------------------------------------------------------------- -------------•----------------- -------------------.------------------------------ \ t ---------•---------------------------------- = - ------- -------------- ---------•---- -------------- --------------- -----------------------------------•------------------------------------ ----------- ----------------------- -------------------- - ---------------------- ------------- FINAL INSPECTION BY:-A. ---- ��------- Date-------- ----------------------------------- SAN ------ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P,CO.