9539 - Laserfiche WebLink

Home Browse Search

,�,p, APPLICATION FOR SANITATION PERMIT Permit No. .___ J�3 -- Q�" •�� (Complete in Duplicate) ll M Date Issued 1 � ZApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ,r This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANIS L CAT! -- ,, _ � / ��** - Owner's Name--------------- _ Phone . ---•-------•-•--- , 1 Z Address-----------------=-•----------- --£-- -------r --- ------ -�-- __ ----------- Contractor's Name ----------- ------ --- _ -----------•------------------------ _ ��_ ---------------- Phone Installation - ----------- - - - ---- - ----- - -- ---- -- - ---•-•--------- Installation will serve: Residence � Apartment House ❑� Commercial ❑ Trailer Court ❑ Motgl El Other ❑ i `` Number.of living units: ____�Number of bedrooms _J__ Number of baths _ Lot size ---46 g$ l „ Water Supply: Public system ❑ Commun'it_y}system_�< Private,❑ Depth to Water Table,�O_'4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sand Loam Clay Loam Y ❑ y oa# ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction; Yes.❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION:AND SPECT !CATIONS: ) (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) } d qk: Distance from nearest well_________________Distance from foundation--------------------Material ______________.-______ ------------------------- No. of compartmenu _Size--------------------------------Liquid depth ' Capacity---------- r ,�Id: Distance from nearest'well._-�""~�'-Distarice'fr:om'found -ra#ion_°__.:______"___..Dis#ante to nearest lot line_________________ y Number of lines--------------- ------------------Length of each line----------------------------Width of trench Type of filter material-------------------------Depth of filter material--------w-_----------Total length_�-----_----------------------------- Seeps Pit: Distance to nearest well_ t I _ __ _________ Distant fo dation"QI_0_:�""Dis'tan'ce�`fo nearest lot line__�*S___:J_ Number of pits Lining material_ Size: Diameter01 • _ Det :; esspool: Distance from nearest wen-----------------Distance from foundation______.__-_:______.Lining material_.____-____________ --_---_--------- ❑ Size: Diameter---------------------------- ! -----Depth-------- ------------- - -- ------------ ---------Li uid Ca aci --------gals. Privy: Distance from nearest well__________ ___ -; 9 __-Distance from nearest building �} ❑ Distance to nearest lot line... l Remodeling and/or repairing (describe)____________________________ - F ------•-------•------- -------------------•-- -----•---- _-1--:----- ------------------------------------------------------- ---------------------•----- t y f. I hereby certify that I have prepared this pplication and that the work will-6e done in accordance with San Joaquin County ordinances, State laws, and rules and gulat' ns of t an Joaquin Local Health District. {5i ned "i g )---------- -- -------4--- / .. � ( weer and/or Contractor), gY: I� �rfi C/ -------.(Title)--- _ ' ---------------------------------------- (Plot plan, showing size of lot;.location of system.in to wells,,buildings, etc.,:can be,placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ _ DATE---- ---------------- ------------- --------------- -- - REVlEWED BY-------------------------------------------- ------ DATE--------- BUILDING PERMIT ISSUED-,----------------- - ----------------------- -_-------------------------------------- DATE--------------------------------------.`----------------------- Alterations and/or recommendations__________________ ----- A' . ___ --------Y,ir----- • --------------- ------------------- -I----------------• -------------------------------------------------------------------------------•--------------------- -------------------------•-••---------------------------- -------------------- ---------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT II 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California, Manteca, California Tracy, California ES-9-2M , Revises 1.57 F-P.Co. a