10895 - Laserfiche WebLink

Home Browse Search

L/ \ ,, A------- 16X APPLICATION FOP, SANITATION PERMIT Permit No. -J - TA. (Complete in Duplicate) Date issued t and install the work herein described. ons)r ct Application is hereby made to the San Joaquin Local Health District for a permit to con t, Ordinance No. 549. This application Js made..'in compliance with CountyW �141GHa)nK 19 - ....... -------7/ �R-/;;---------------- es -A,,,D LOCATION__4ec.7 - --------- .7 JOB ADDRESS . ...... --------*X_ Phone--------------------------------- Owner's Name_____________ ---------- .. ................ Address---------------- ------y-l'oe----------------------- Contractor's Name----------------------•- Apartment House Commercial ❑ Trailer Court El Motel Other Q, Installation will serve: Residence [I X-ea Number of living units: ___/--- Number of bedrooms --.oT- Number of baths __/--- Lot size -------` ow Water Supply: Public system El Community system [I PrivateDepth to Water Table It- Character of soil to a depth of 3 feet: Sand Fj Gravel 0 Sandy Loam El Clay Loam [I Clay E] Aclobe; Hardpan-Ej Previous Application Made: Yes El No New Construction: Y E]No FHA/VA: Yes [] No / TYPE OF INSTALLATION AND SPECI F1 ATf IONS: available within 200 feet.) [No septic tank or`cesspool permitted if public sewer is Septic,Tank: Distance from nearest well---,)r--------Distance from foundation__. -----------Material-----0/9 ------------- - -?, Capacity----ompartments---- ------ -- -------- Liquid depth---r07e---`*--------C No. of c _12----------------size " ---A- C".-_Distance to nearest lot line_- i pis Distance from nearest well_- ___.----_.Distance from foundation —---------- al Field: ------Length of each line---:----__ - ------Width of trench----- ------------------ Number of lines---------/---------- 4?0--- r Type of filter material--------.414e�Depth of filter material----/9------ _-Total length---------7-- -- -------- --------- rest well--340-------------Distance from founclation__;IV--------Distance to nearest lot line__---------- Seer)agie Pit: D�stance to nearest 1W ------------- Number of pits------ -29 le---Size: Diameter____,_,,LT---------Depth ----- ------------Uning maferial-)-e 9 Lining material__._.--------------------------------- Cesspool: Distance from nearest well-________________Distance from foundation-------------- Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity------- ------------------- ❑ tance from nearest building------------------------------------------ Privy: D:stance from nearest well-------------------------------------------------Dis ------------------------------------------------------------------------- ❑ Distance to nearest lot line----------------------------------------------------------------- 4 Remodeling and'/or repairing (describe):---------------------------------- --------------------------------------------------------------------------------------- --------- describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ------------ --------------- -----------I----------------------------I------------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 rules and/wg ations of the San Joaquin Local Health District. ------ --_---(Owner and/or Contractor --------------------(Title)----- ------- By--------------------------------- ----------------------------------------------------4 (Plot plan, showing size of lot, location of system in relation to wells, buil djigs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY A V-01 DATE------ -------- APPLICATIONACCEPTED BY------------------------------------------------------------------------------- ----- DATE------ ----------------------------I------------------------- REVIEWEDBY----------------------------------------:---------------------------- -------------------------------------------------------------------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED---------------•------------------------------------ ----------- Alterations -------------- -------------------------------------------------Alterations and/or recommendations:-------- - -------- ------------------------------------- -------------------------- ---------------------------------------------------------- 57--1_ ------ --------- ----------------- _3R=-----------PIT------VEFT4---------- --------ax--------------------- ------------------ _r P- -1=------------q.,9------�Fmg-—----------- ------ ---------------- ------------ ------- -----1/t� "-4-------A"A ------------------------- ---- -------- ---------------------------------------------------------------------------------- ------------------ ----------------------------------------------------- --- ------ ---//--------- - ------------------------------------------------------------------------------------------------------------- --------------------------------------- --- —-------I-------- K� -,TION BY -- ------ --- Date-------- _7------------------------------------------- FINAL INSPE-C R ---- ------ --- -------------_a SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street TracCalifornia Stockton, California Lodi, California Manteca, California y, ES-9-2M RovisecL 1-57 F,P-CO.