9281 - Laserfiche WebLink

Home Browse Search

�IA �1 APPLICATION FOR SANITATION PERMIT Permit No. ------ 7K '' (Complete in Duplicate) ��- Date Issued application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applica io is made in coropliance with County Ordinance No. 549. a JOB ADDRESS AND LOCA ION-- ___ ----'_fXi Owner s Name-- .? �-- ]� Phone------------ --- /� Address"------------- ------------------------- ---------- : Phone----------------------------------- I Contractor's Name-----_---- - ---—- Installation will serve: Residence [[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rooms -%Y -- Number of baths _/__ Lot size _,/_x-466 - -•--------------- Number of living units: I---_-- Number cf bed Water Supply: Public system ❑ Community system ❑ Private W?*Ibepth to Water Table it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No P' ' New Construction: Yes ❑ No g4- FHA/VA: Yes ❑ No 94—` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ . Septic Tank: Distance from nearest well------------------Distance from foundation___--------------- ----------------------- F1 ________________Material______._-__._________. _____.____"._"_.__,__.. Size----------------------------- q p. ❑ No. of compartments-------------------------- _ Li wd de th--------------------------CapacstY----- --------�------ Disposal Field: Distance from nearest..well____._- :.Distance from foundation-------------------_Distance to nearest lot line___-_______-__-__ ❑ Number of lines---------------------------------'Length of each line------------------------------Width of trench--------------------------------- Type of filter material-----------------'-------Depth of filter material---------------- ----Total length------------------------------------------ W ' __...__..Distance to nearest lot line_^'-_-_._.- Seepage Pit: Distance to nearest well-- -�.-------- Distance from #o dation_- f� N Size: Diameter .----------- Depth - {� 1 bq' Number of pits---- --------------Lining material __ 1 Cesspool: Distance from nearest well-----------------Distance from foundation-------------_.____.Lining ❑ material____-____._--____--.___:----_-_____ ,De th--------------------- ------------------------------Liquid Capacity--------------------- Size: Diameter-------------------------- ---- Privy: Distance from nearest well-_______________________ " ---------Distance from nearest building---------------------------------------- `i ❑ Distance to nearest lot line...---.--------- ----- . t• y ----- Remodeling and/or repairing (describe):_"_____________ �, ---------------------------------------------------------------•--- - - ------ ------------•------------------- -------------- --------- --- ------ . i 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _ F ' i (Signed) O - ar Contractor) J ( C t tor] Si ned - By:--_----------•---------- - --�---- � ----------' ----- ------(Title) showing size of lot, to ion of system in relation to wells, buildings, etc., can be place on revers (Plot plan, 9 -_ FOR DEPARTMENT USE ONLY DATE------------------ d_r�—--------------------------- APPLICATION ACCEPTED BY------------ --------- --------- --------- ------ ---------------•------------- •--------- 0 REVIEWED 13Y DATE--- ---------l�t -----------------------•------------ PERMIT ISSUED--------_------- --- ---------------------------•--------------------- ---------- ----- DATE------------ ------------------------------------------------ BUILDINGk Alterations and/or recommend ations•-------------- _____.-"__-_________________._________ --- —`� tL-7------! `T -�------x�' Wiz" � ; ------------------------- ----------"- ------------------------- ------------------------------------------------- --------------------------------------- Y -- j -------- ------- --------------- t AY ----------------------------------- FINAL ----------------- BY: -- Date------------��--�--t�-�--'.��- ------- --------- 1=1NAL INSPECTION - ----- -- -- ----� -�.,� --------•--_=--------+ t t SAN JOAQUIN'LOCAL HEALTH DISTRICT ` 300 West Oak Street "'9 132 Sycamore Street 814 North "C" Street 130 South American Street '• frac California Stockton, California Lodi, California u Manteca, California y r a ES-9-21x1 . Revisea 1.57 F.P.CO.