10165 - Laserfiche WebLink

Home Browse Search

0(1�( APPLICATION FOR SANITATION ✓ ON PERMIT Permit No. (Complete in Duplicate) / (p Application is hereby made to the Sen Joaquin Local Health District fora er Date Issued /�-�/S� This application is made in compliance with County Ordinance No. 549, p mrt to construct and insta€I the work herein described. JOB ADDRESS AND LO ATION___ �„� �- Owner's Name---•__ � -- Address___--•-•-------•-•- ---•---•---------------- ------------------------ {`= -- ------- -------------- -- one ' Contractor's Name Installation will serve: Residence ..._ -------- ------------------- -- -- / ----•---------- ------ Phone_.1,� '911//4 Apartment House ----�-"-"---" ❑ Commercial --'--•-------------------- Number of living units: ----- --------------- ---- Number of bedrooms -- ❑ Trailer Court Mote€ Water Supply: u ! Number of baths __-_ - ❑. Other � PP y: Public system -- Lot size ___-. ❑ Community system ❑ Private -'-7 .X-1-j' Character of soil to a depth of 3 feet: Sand Depth to Water Table -_A Previous Application Made: Yes ❑ Gravel ❑ Sandy Loam New ❑ Clay Loam [] Clay E] Adobe TYPE OF INSTALLATION AND SPECIFICATIONS:Construction: Yes ❑ No ❑ ® Hardpan [] FHA/VA: Yes � No E] (No septic tank or'cesspool permitted if public sewer is available wifhin 200 feet.) Septic Tank: Distance from nearest well -------------Distance from foundation-_____-__-_ N No. Of compartments--------------------------Size-------------------------------- --.Material --------------------------------- Disposal Field: Distance from nearest wellx_:_�_ 0 Liquid depth_-----_ Capacity-------- Number of lines --"-"---Distance from foundation_____b-"�_ 1---------- - Length of each line-------____. Distance to nearest lot line__"___� d-;--- Width of trench------ `> ype of filter material �.�"�-�- -.pepth of filter mater�al____,�- See a e Pit: --------Total length------ 0 P g Distance to nearest well-----"- - O l; +$ rstance from foundation_____.lr-� ®+ Number of pits---------- -------Lining material_____ d C Distance to nearest lot fine_ - " Cesspool: Distance from nearest well-----------------Distance from fr�ndaize: Diameter_______ i��" �'�--�- ---- Depth--- Size: Diameterq - --------------------- material--------------------------- - ------- ---- ----------------• r, Priv -- - ---- ---- ---- ----Depth----------------------------- --- - ❑y' Distance from nearest well._-_------- --- -------------Liquid Capacity----------- ----------------- -----------Distance from nearest buildin ----------gals t0 Distance to nearest tot line--------------------------------------------- p -- ........................------------ "_. N emo eling and/or repairing (describe)---------------446v --------- --------- ------------------------------------------------ ---- --I----- ------------------- --- ------------------------------------------------------------- -------------------------------- -----------------------------------------. .._ - ereby certify that I have prepared this application and that the work will be done in accordan ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r ce with San Joaquin County (Signed)....---11.0 D3Gy '1'-- BY� _ Ti (Owner and/or Contractor) (Plot plan, showi size of1fo}, Iota}} on of system in relation to wells, buildings, etc., can(bel placed on reverse side�]�...... "' . ---."----"-- FOR DEPARTMENT lJSE ONLY APPLICATION ACCEPTED BY_______-_-_ REVIEWED BY............................................ -- - DATE BUILDING PERMIT ISSUED---------------------- ------ --_-r--- ______ DATE ----------------------- ----------------------- --- - Aiterations and/or recommendations: --------------- DATE ----------------------- -------- r---------------- - �� ' -==== :::: .. : :::::: ------ ----- ----------- ------ --------------------- ----------- - ----- - - -- - - - -- -_ --- ------------------------------ ------------------------ ----- --------- - ---------- �,----- ----------- ar `- -- - ----------- -------- - - FINAL INSPECTION S . - --- - - Date 130 JOA ---------------------------- Stockton. ----- -------------------- 4 OCAL HEALTH DISTRICT f30 South American street 300 Wes+ Oak Street Stack+on, California 132 Sycamore Street Lodi, California Manteca, California 814 North "C" Street ES-9-2M Revisea 1-57 F,P.Co. Tracy. California