8711 - Laserfiche WebLink

Home Browse Search

4APPLICATION FOR SANITATION PEKi*.... it No. ------- a — 's I" (Complete in Duplicite) D�ate:hssued Ap P lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereii4 described. This application is made in compliance- with County Ordinance.No. 549. JOB ADDRESS ANDfCATION ( -A,< -------------- ------hl/.4, ------------- ----------- ... 3- Owner's Mame-- - ----------------------------------------------------------------- ------- Phone----•-----=------------------------- r Address hone----------------------------------- Address--------------------------- ----------------------------------------------------------------------------------------------------------- Contractor's Name--- -_- - -----I------------------------------------------------------------------------------ Phone----- ------------------ Installation will serve: i Residencer.f Apartment House [3 Commercial El Trailer Court El Motel El. Other ? Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------------------------------------ Water Supply: Public-system Community system E] Private E] Depth to Wafer Table.3-17- ft. Character of soil to a depth of 3 feet: Sand E] Gravel [-] ' Sandy Lown El -�Ciay Loam E] Clay E] Adobe E] Hardpan 0�_� Previous Application Made: Yes [] No E] New Construction:;Yes Ej No E] FHA/VA: Yes E] No ❑ TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-SO-------Distance from-found cit'Lon—Za------';�---..Maferi3I----ol"C't-e No. of compartments.-- !!7�------______SizeI,—...ly --Liquid depth__-_-"""�t--------------C lk /AV V-2wx-s-. apacity_/-(79T� Disposal Field: Di'fan'ce from nearest ell,.�-----------Distance from foundation--- Distance to nearest lot lin ------------- OT ---31 __�_____.._.__Lengfh of line----------- trench----- - ---------- -(_ _�Wicliln of o ? -- Number of lines----_--- ZY—)-]____ 0 Type of filter materia!__- Depth of filter rnaferial,/l---r'I_--_._Tofaf length_-_-----_/4 -------------0;10 Se Cesspool: Distance fi'om nearest well----------------Distance from foundation---- ------ ..Lining material_.-.--__---------_-.---:._-----__--_.. . ❑ Size: aterial------------------------------------ Size; Diameter.--=---#-- -----=-----------=-----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: O;sf6n,e from:rearest-well!: -- --- -- ----------- ----- _.:Distancefrom-nearest-building-'---------—-------------------------- -- - - ❑ Distance-to nearest'-lot line:-.-.--- -- A-—-----------—-------------------------------------- --------------- -------- --- ------------------------------------------------ Remodeling and ---------------------------------------------- ----------------------------------------------------- /or repairing-(clescribe):-------------------------- ------------ ------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------*------------------------------ -- -------------------------- ----- - I hereby certify 1 that I havepreparedthis ap plicafion and fhat the work will be done.in accordance with San Joaquin County ordinance;, t%laws, and rules and regulations of the San Joaquin Local Health District. ------- or) (Signed) ------- ------------W14. -ALAP,----------------------------------------------------- -----------------------------------(Owner and/or Contract By:------------------------------------------------------------------------- ------------------------------------------------------[Title)-----------------------6---------------------------------------- (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---------- --------------------------11------------ DATE - --------- REVIEWED BY----------------------------------------- ---- ------------------------------------------------- DATE BUILDING PERMIT ISSUED--..------------------------ ---------------------------------------- DA ------------ --t-f---------------- --------------is - A TE ------ ------- ---------------------- ------- --------------------------- Alteratiops and/,f recommendations:--------- -------- ------------- -------------- ----- --------------- ------- ...................... ��J; _- �7 ----------- • - W�_-------- --- --- ----- 61- /A. ------------------ 06- ee- - -------- ..... ...... ---------- --------------- ------------------------- ------------- - ---- --------- --- -- ------------------------------------------- --------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------j---------------------------------_------------- -------- FINAL INSPECTION BY:, ------- Date -------------- ;4 ---- --------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A Reviseo 1-57 F.P,CO.