10154 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) U� ,f O Date Issued Application is here ymade-to fhe San�Joaquin Local Health District fora permit to construct and install the-work herein described. This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND CATION.--•--=/ 6 f ' , -'------------------------------------ ------------------------ N Owner's Name--------- -- ----------- -- ------ -, ------ ' '---------------- Phoney Address u - ------ ---------------------- /----- Q Contractor's Name = . -. � Phone. Installation will serve: Residence A artment House D Commercial ❑ Trajler Court ❑. Motel ❑ Other 0 k } ' Number of livingunits Number of bedrooms ____ Number of baths --__:__ Lot size I .-"'Water Supply: Public system' .' Commurii+y system ❑ Private ❑ Depth +o'Water Table '°:.____ ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes 0-' No ew Construction: Yes ❑ No FHA/VA: Yes ❑ No I,- TYPE ,TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or'cesspool permitted if public sewer is available within 200 feet.). S is .Tc�T1c. istance from nearest well___.___-.___r.__-----,--Distance from foundation__________ ""_ Material______�________________________________________ �o. of compartments------------- - ------•-- _ q i? ----- ----- --- - CapacitY Disposal FSI Distance from-near esf well___------- __`:D s+ance.from foundation uid de th- Distance to nearest lot line----------------- Number of lines--- -------------------------- tLengfh of each line---_----_._______ _E----_:width of trench.-----------------------------•--- } , Type.oflfilter material_,_` --------Dep+h �f filter material____'____+__- ___{_Total length-,s ^l. ' t �.•? r - Seepage Pit: Distance +o.nearest weII7/-L7Q�i✓Dis+ante from foundation_-_�'a:= ""Distance to nearest lot-iine---�___. I Nu'm'ber.of pits:."_-_._____ Lining Diameter___;.-..'.......Dept h------as-__ ---------- CessCesspool: ool: Distance from nearest well-----------------Distance from'foundation__:`_:'`_ _,_.____.Lining maferial------------------------._______.__.`r Size: Diameter.----- Depth.- - --=----=---_-.-f._-.rl iquid Capacity gals.p� --------:---Distance from nearest buAcling------------------------------------------- ---------------------------------------------------- Distance Distance .. —•��... -------- -----------t rqm nearest we ----------------------------------- uil ❑ Distance to nearest lot'kine_-=.~�'-------------- ------------------------ _ ___--,_ _-J-�--------------_---- -------- Remodeling and cr regia n '(describe):- �f1d 12__ ' f/ i•, C � ISI _(ju�j ___ f �_R _ - _ __ �i_ . ' ._# -V. x �• � + , 4. - = = - --•-------------•-•-_--._-----_---"----------------------------- : ' ="° = 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 nd rules and re ulations of the San'Joaquin Local'Health District. (Signed) 0----= �%'�' ,�-V, - ------------ - - ----- (Owner and/or Contractor) y - By:---•------------------ --- -- -- --r- - {Ti+le) '1 ^ (Plot plan, showing s' of lot, lot ion of system in relation to yells, buildings, etc; can be placed on reverse side). f`. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ zi ----------- --------- ------ DATE-------9/ 23:.� ----------- : r -_ '=. DATE--'--,REVIEWED ` REVIEWED BY - - z BUILDING PERMIT ISSUED---------------------------------------'.---------------------------------------------------- - DATE:---' = i------------------------------=----------------- iAlter i ns nd/ reco mendations: -_ -- ---------- ------- -------------------------- ----- ----------------------------------- ` f--------=�------- --- ------ ------- . -------------•--------------- ------- -------- = . ---- V - = ---------- -- --- - --- --- --_ Y , "(A/FINAL iNSPECTION BY:. = -----=----------- Date---- _ -l..Q ------------ ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oalc Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M , Revised 1.57 F.P.CO.