10942 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the Sa-n Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in complian��e-with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------- --------- V---.---- --4- -------- Owner's Name--------------z:: -�--.---------/J---. -a_0E4-2----------------------------------- ------------------- ---------- - --------- Phone----------------------------------- Address-------------------- r -ll---- F ----- . .�C Phone_ - �----- ---- --------- Confiractar's Name--------------r= ----- ------ • � Installation will serve: ResidenceApartment House L] Commercial ❑ Trailer Court ❑ Motel ❑ Other [INumber of living units: __. ___ Number of bedrooms ��Number of baths j--- Lot size _____� _______________ Water Supply: Public system Community system El - Private E] Depth to Water Table �Sjlf. Character of soil to a depth of 3 ee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes E] No FHA/VA: Yes E] N0 { TYPE OF INSTALLATION AND SPECI CA ]ONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ptic M . snce from nearest well_________________Distance from foundation______-_-- __.____.Material__________-.___---____-_______________-_____----- ' ' No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal-F'ed"' Distance from nearest well--J/V&6-Distance from fcundation__,!D _______Distance to nearest lot line--��____ Number of lines________ ____ _____ Length of each line_____ ___ Width of trench_._ _�,�f-----__.--------- Type _____ ._Type of filter Depth of filter material____. ---Total length_____�C'1___°___________---_____� Seep e Pit: Distance to near well- �� __--Distance f om foun ation____ _._____-Distpnce�to nearest lot line__ ____ Number of its.----- _---------_ / _Size: Diameter---------- ------------Depth----- - --. p' � --_Lining material____ �1 -�� ------�------ Cesspool: Distance from nearest wel!-----------------Distance from foundation--------------------Lining material------------------- _____ ❑ Size: Diame#er-------------------------:------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------.__._. ❑ Distance to nearest lot line---------- -------------- .-I.--.--. --- --------------------------------------- --- - �_ _z'1 ' Remodeling and/or repairing (describe:-- '`�- ------------ --- -------------�-`-��---------- `� - -L,�------•-- ---,-��-°-�"�- _=�-... - - �"^a --------------- ----------------------------- ----- --------•----------------------------------------------------------------------•-----------------------•-------------------------------------------------------------------------------- I hereby certify that I have prepared this application and tha+ +he work will be done in accordance with San Joaquin County ordinances, State la .s and rules a egulations of the San Joaquin Local Health District. (Signed --- �' '---~--------�-----f '----- wrier an�rConlractor] 117 By:------------------ --------------------------------------------------------------------- - --- ------- ----------------{Title}---------- -- � (Plotpian, showing size of lot, location of system in relation to wells, buildin 's, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ------- DATE---------- -___-- REVIEWED BY--------------------------------- - 1 , 7 3 - DATE--------t-- - `� BUILDINGPERMIT ISSUED--------------------P------- -------------------------------------------------• DATE------------------------------------- Alterationsand/or recommendations-------------- ------------------------------------------------------------------------- --------------------------------------------------------- I ---•------------------•-------------------------•---------------------------------------------------------------------------------------------- ------------•----------------------------------------------------------- ---------------------------------•-----------------------------------•-------------------------:---------------------------------------- -----------------------•-•---------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- ----------------------------------•--------- ---------------------••-•--------------------•-----------•---------------------------,------------------------------------------------ FINAL INSPECTION BY:----- Date------- / - ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street S+ock+on, California Lodi, California Manteca, California Tracy, California ES-9---2M . Rev'ssea 1-57 F.P.CO.