8990 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _v'_/•"�-� "" (Complete in Duplicate) . .. 5, _ - ,.-v _" � �l Q_ ��F•�[ '.. ° -. ;_ "-" _ .T.�,..�.�.�.. Date Issued f = ! j f�, L-�- i Application is hereby made to the San`Joaguin Local"Health District for a perm_ it to construct and install the work herein described. This application is made in compliance with ounty Ordinance No. .549- F I - � 00/— JOB D/JOB ADDRESS AND LOCATION'. `' Owner's Name- -- - = - - Address------------ O �, . .. -- —----- - ' { Contractors Name----"146 < i. Installation will serve: Residence E -------------------------------------------- ------- Phone. s_A partment_Hous6' Commercial ❑ TrailerCourt 1 y� _ ❑ Motel ❑ Other ❑ Number of living units: :_ Number' of bedrooms -- �- �_ L I "�// PPY. y ❑�"Communit 's stem"} Private De thhs C- Lot size -_+�_f�_' { 'LJ Number of bat Water Supply. Public s stern � - " ' ' -" """"`""" - Y.. Y ❑ M p 'to Water Table -ft: v- *- t Character of soil to a depth of 3 feat: Sed [] Gravel ❑ Sand Loam Y' ❑ Clay' Lnam ❑ Clay ❑ Adobe Hardpan [� Previous Application Made: Yes ❑. No 0' •_.New Construction: Yes No 4 A---� _ ❑ ❑ FHA%VA: Yes ❑ No ❑ TYPE,OF INSTALLATION AND SPECIFICATIONS: .,a; '� { (No septic tank or cesspool permitted if,public sewer-is available within 200 feet,) Septic Tank: Distance from nearest well � Dr ante from o datio1 0_` 4-'� L � No. of compactmerits . -a.- ?-'Siqk��C "� " M i "0451 --�'-� ter"a! I depth ' Cepacfty_ Ligwd r .y 1- x --------- Disposal Field: Distence from±nearest-weft .- _Distance from foundation '-� �t ! n•, Number of lines_# :_ - _ -- Distance to;nearest lot line,_____-""--- ' Length .of each line $o _�_0.`:Width of french-A*--"_---• - ^�'} t Type of filter material .__`' :. _De th,of"filter material"'� e" - " «.+ "p""T Total :length'1" -.t9: ------------- a ---------------- Seepge Pit: -'• Dietace.to nearest well__t____ ___-_ Distance•from`foundation '___ "" ' -.Distence to nearest lot line__"_"----,_."""� ❑ Num4�er of pits. -- Lining material . Size:.Diameter "" - Depth Cess ool: p Distance from nearest well----------------- from foundation------------J----- Lining material----.___"___:" ❑ F Si se: Diameter_ i= ------------------- Depth------------------------------------- 1 :=-------------rLiquid Capacity------------- f .gals .. ! i- Privy: Distance from nearest-well----_.----__--___-______----------------------Distance from nearest building ❑ Distance'to nearest lot iine�_ a..... _ g- ------- t - Remodeling and/or repairing (describe) j �' ` '' + a -,I„ _ ------ ---------------- ---- - -' - """ --- •--•-—-----------•- ` ---- -----, i" - ---==---- ---- ---- T' t f._ � . ' ------------------- --------------------------------- ------- _ -------------------------------------------------.-------- ------------------------------------•--------------------------- 1,J`. I hereby-certify that I have prepared this,application and that the work will-be done accordance with San Joaquin Gounty(` ordinances, g I Health District. (Signed)___ t e laws, and rules and � s of he San Jaa urn Local c „ � � 6. ------ --- ------------ ------ F y * .E �� } -1 ---(Owner and/or Contractor ..- ,. .___.�"" ----(Title) - -(O r = --------------- -- --------•-- ----- --- (Plot plan, showing.size of lot, locatiori.0 system in relation',to wells, buildings, etc.; can'bert laced on reverse side}, f - 5 g ' F P T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - -___-- -- -- ---- --------------................... ------------------------------------------------ DATE"."T a - REVIEWED BY--------------------------------------- •------------- -- ------- --------------------------------------------=----------- DATE --------------- ------------------------------- BI�ILDING PERMIT1$511ED_________ �-----__:_,__"_ � - ' ------- -- --- -- ---- ----- ------ D Iterati s and/or re ommendatio s: '. ATE --------"------------- -----------------•------- I „-- ------ ---•---------------------------••-------•-------------------------- --------- --- ----I----------------I----------- - 4 -- ----------• -------•----•-----•----•-----'------•--•---»•-------•----•-------------- -------------- --------- --- JJ ..' ' ,.- ------ ---- -----' "" 4<_ - - ---•------------ --- ----' -----'------FINAL INSPECTION BY .� ------ Date:----�-----___--- '-- -_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oe1c Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California � Tracy, California ES--4-21x1 , Revised 1.57 VPM, /