11479 - Laserfiche WebLink

Home Browse Search

J • APPLICATION FOR SANITATION PERMIT Permit No_. -- -"��•�'� (Complete in Duplicate) Date Issued ___._�L��/ 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 O ' ante No. 549. CPO JOB ADDRESS AND LOCATION -- --------------------------------- ' - Owner's Name-----S�_(:K.TOZ-=-- _ ctt 4 J= �---- y �� Phone one - -- ------------------------ Address -j- y�-- - --- �€ ` -------- ---- -` Contractor's Name------------T� Q � +� �.------------------C-------Ri' �� ------------------------+Phone�_�-----t-------------------- Installation will serve: Residence ® iApartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other El Number of living units: Number of bedrooms ___I__ Number of baths -------- Lot size ------------k____________ _ Water Supply: Publics stem Community system / 4 pp r� y �. I y y ❑ Private ❑ Depth to Water Table� ft Character of soil to a,depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam [_1 Clay Loam El Clay s[] Adobe R,Hardpan ❑ r i Previous Application,Made: Yes ❑ No ®t New Construction: Yes ❑ No W--FHA/VA: Yes Fl� No & TYPE OF INST,<LLATION AND SPECIFICATIONS: ' (No septic tank or'cesspool permitted if public sewer is available within 240 feet.) S ,tic ank: Distance from nearest welf-------_----_---Distance from foundation---------------------Material---------------- opr . .........S . Liquid depth----------------'--------Capacity--------------_ Dis osaiDistance fromnea _______est wellp LD ----- -_ Distance �-_-- • to nearest lot I�ne__-_1----.---- Number of lines--------------- -- ------- --------Length of each line------(�&o-�---- Width of trench------�----------------------- Type of"filter aferiaL _ --Depth of filter material-------_m _t&- __. Total length'----- 6141-1------------------ page P Distance to nearest well_.___ __ $iN:F ___Distant m ndation------ }.-------Dista rice to nearest lot line---- - -_ Number of pits._-__�_f--------------Lining materi ___�__ 1 ' _.Size: Diameter--_4-`X_6-1----bepth___.6__r--- --------- Cesspool: Distance from nearest well------------_----Dist ce foundation--------------------- material--__._----------_-._-______--__----- ❑ Size: Diameter-------1---------------- ------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. r Privy: Distance from nearest well------------------------------------------------Distance from nearest building____._.--____________---__---__-_-__.__. ❑ Distance to nearest lot line------------------------------- ------------------------------------------ Remodeling and/or re airing {describe): - 7---------------------------------------- , = -- -- �Urdthis'applicaflon ------- -------------- _________ if�4 = -----------------------� -------------------------------------------------------------- --------- I hereby c rtify that I h e pre and that t e work will 6e done in accordance with San Joaquin County ordinances, State laws, and es and regulations of the.San Joaquin Local Health District. ; T : R (Signed)_______ - - ----------- -- Q ---- -� --------_--- ' V (Owner and/or Contractor) 6 { Y• (Title)------------------------ ---------' 1 (Piot plan, showing size of lot, location of system in relation to wells, buildings,-etc., can be placed on reverse side). . _ •� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- I'--------------- ! ------ ---------------------------------------- DATE s7 REVIEWED BY------------- ------- --. -' r 3 f ------------------------------------------------ DATE �'� ----------------------- BUILDING PERMIT ISSUED----------------------- .--- . P- ------- ----=--=- ---------------'------:---- :--------- ---------- DATE--- ----------------- 1 Alterations and/or recommendafions:---------- ----------------------------------- ----------------------- ----------------------------------- I - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- r --- ---- --- ---------------- -- ----------- ----------------------- ----- ----•------------- FINAL INSPECTION BY---------------- - ------ - ---• ---------- Date----- --- ----- ---,------------ - -------------------------------- SAN -------------------- - SAN • JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES--9--••2M Revised 1.57 F.P.C6.