11001 - Laserfiche WebLink

Home Browse Search

S•� APPLICATION ATION FOR SANITATION PERMIT Permit No. _-/,[_r1.._ '-_I f (Complete in Duplicate) bate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct,and in tali t e work herein described. This application is made in compliance with County Ordinance No. 549. S` •$ d' JOB ADDRESS AND LOCATION.-_ IS-- = .� -------- `` � � (( ---------------------- � Owner's Name---------- - ---C��-�(��--t.�J--l"T--�---- - -- Y—k -------------- � - ---------- ------------ --------. Phone--- -------------------------------- Address ----------- ------------ ------------------------------------------------------• -------------------------- Contractor's Name __ __: '-------------------------------- Phone--t Installation will serve: Residence Ej Apartment House ❑ Commercial E❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "f_-----Number of bedrooms--- Number of baths __�--- Lot size __---- `--- ' ----•-----------•-- Water Supply: Public system r Community system ❑ Private ❑ Depth to Wafter Table."/a ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: Yes ❑ No �j New Construction: Yes El No ( FHA/VA: Yes ❑ No "I� , TYPE OF INSTALLATION AND SPECIFICATIONS: TIONS: f I _ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ti SepWA Distance from nearest well---___---_------Distance from foundation_ ' ( No. of compartments_----------- --------Size_ ---------Liquid depth------------------ Capacity,, FF P ------------------ -f-- Distance Id: Distance from nearest well.__/[$ `_-_Distance from foundation---__/__Q_-__ --Distance to nearest lot li��_ ___---_•� -Length of each line__ _ ` ]r Number of lines_)_----- - � ---- l Width of trench.__- f Type of filter material"---__ } a�� Depth of filter material-._-l Total length. � f See e Pit: Distance to nearest well_--jJ.a�F_-__Distance-from foundation---1_0...........Distance to nearest lot Number of pits"-- ___�--___---_____Lining mate ria l-_PVClKf----Size- Diameter__-- - -- Depth_ ` Cesspool: Distance from nearest well-----------------Distance from founda+ion--------------------Lining material------------------------------------- ❑ Size: Diameter_' I -----------------------Depth---------------------------------------------- -----Liquid Capacity--------------------------gals Privy: Distance from nearest well------------------------------------------------ Distance from nearest L�uildin g t ❑ Distance to nearest lot line--------------- 9 and ____________-.___---__________- •_ Remodelin n be :---_, f and/or repairing pirig �descrii ) - �B_94-�-�- ----�*�-------L-L--.e��:.f�- -�lZ-/��-A•�-------•------ -- --------- -- - --------- •----------- _ ------------- -- -- -------- - ir------ X—>I---=-Fb•---------- - _-C '"�---------------------- --------- ------------------------------------•------------ 1 ---- ------ ---- - " -- ---- -- ------------ - --- ------ ------ --- ------- -- - - - 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, and rules and regulations of the San Joaquin local Health District. (Signed) l � 1 S �� ('' { / `� ---_Owner-and/or Contractor) BY: ----------------------- - - -- ------- (Title ?f —--------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i } FOR DEPARTMENT USE ONLY ` A APPLICATION ACCEPTED BY------- - - - - ti"r,--: DATE ----------- -- REVIEWED BY------------------------------------------------------------------ ----------------------------------------------------------- DATE BUILDING PERMIT ISSUED----------------------- ----------------------------------------------------------------"---------- DATE-'------------------------- --- Alterations and/or recommendations:.1--------------------------- - ----------- � r.44 s g; r ---------------------------------------------- ,. -------------- •------------------- -------------------------------------------------------------------- --- - ---- FINAL INSPECTION BY: `r-------------------- --------------------- Date-------------- - ---------------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ` 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California ! Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revises 1.57 FP,CO.