9136 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued _-9/� /`S-7 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 in compliance with County Ordinance No. 549. -_.-._--_ -_-_- __------ ------------- --•- JOB ADDRESS A D -------- --- -------------------------- phone Ay ----------- -------- -- --------------------------------- ------ ---------------------- ------ Owner's Name-- ---------- --i ___________________________ _______________ Address_..----•--------- --- Contractor's Name_- .------------------------ ' Phone --. Trailer Court Motel ❑ Other❑ , Installation will serve: ` Residence ='Apartment Nouse ❑ Commercial ❑ ❑ � ---------------------f- Number of living units: __1.:__ plumber of bedrooms -_. _ - Number of baths ___ ___ Lot size -_-_6_0------ Water Supply: Pubk'system"[+Community system ❑' Private ❑ Depth to Water Table ---------ff. obe _,,,_H-r�'�san- Character of soil to a depth of 3 feet: Sand E] Gravel [ISandy Lo�PNo Clay Loam El Clay ❑ Ad .� ❑ Application Made: Yes []{ No � New Construction: Yes L] FHA/VA: Yes ❑ No ❑ Previous pp TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank cr,cesspool permitted 'f publicsewer is available within 20D feet. ra Septic ank: Distance from nearest we 144 Distancg fro/m� foury�lation__._____.____.____.Mat r�L___________________�"� • s 4 " :Size_ __ `2 �G o� Liquiddepth Capacity - 7i�'✓ 3 Capa •ty _i �i+� .No_.of compartments_____- . _ . 0stance to nearest lot linaR{- ___ Disposa Field: Distance from nearest we __ _______ ____Distance from foundation _ Number of lines---__----.9--i-va ---- ----------Length of each line------------------ Width of french_------- _ -!__•---------- Type of filter materi �- Depth of filter material_______----_---Total length_______.._-" "-- ---- --- - . _ .,:1 Seepage�Pit: Distance to nearest well_-______:_�.__".____Distance from foundation___.._______...___.Distance to nearest 4ot line_________________ , Linin material-----------------------Size: Diameter Depth ❑ Number of pits--------------- ------ g .. = Distance froil nearest well____.________ :_'Distance from foundation--------------------Lining materiaL,_'____--"-_________--___'_-__ ___--- Cesspoo: Liquid Capacity--------- ----------- -gSize: Diameter------=------------------- ----- -;Depth---------:--------------------------------- -------- Fl --- + ❑ -Distance from nearest building Distance from 'nearest weft--------------------------------------------- r, ---------- ❑ Distance to nearest lot line. --------- ----- I Remodeling and/or repairing (describe):--------------------------------- ------------•_----•------------------------------ ---------------- -----•----=--------- ----------------------------------------------------------------------- ` c , I hereby certify'that I have prepared this application and that the work will be done in accordance with San-Joaquin County ordinances, Sta a laws, and rules and regulations/of the San JoaquifPLocal,Hdajth District. _ " ''Ps� ''� .................. ------------ ----(O and/or Contractor) �_ - i (Signed --- ----- ---------- ------ --- - 1 ---------- ------------' , - °---------------(Title)------------------------- 8; , ------------------------------------------- •-- - ---- -- -- -r. (Plot plan, showing size of lot, location of system in relation to wells, buddi igs,' etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-j�- - - DATI= ---------------------------------------- ------ ----------------------- i4 - ---------------" DATE--�------------------------------' REVIEWED BY ------------------------ DATE - -- ----------------- - BUILDING PERMIT IS ED------------------------------------------ I Alterations and/or recommendations:---------------------------------------- ---------------------------------------- ------- I ---•-------------- -------••---•--- ___ ________________________"._. ________ ___________"____ "____ ---------------- ---- -----__ ------------------___________________________________________- -- --- ---- _ ___ ____ -""..r ___-_----------------------------- ---- ='--------- -" 'Date--Date --- ------- --:- I=INAL INSPECTION BY."_____P—_t-= ---------------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT r! i 300 West Oak Street 132 Sycamore Street 914 North "C" Street 13o South American Street Stockton, California Lodi, California Manteca, California Tracy. California sy . ES-9-2M Revised 1-57 F-P.CO.