9974 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ...... 1 � (Complete in Duplicate) - � Date Issued ____ __�_ e- Date is hereby made to the San Joaquin Local Health District for a permit to construct and instal;the work herein described. his application is made in compliance with County Ordina ce No. 549. 1 OB ADDRESS LOCAT N____ ___ � k / l �. y� 1 ---------------- ll 1 /F "4jPKA ne Owner's NaT � -r �r - - ---------- Ph° C/ j .. . , i Address -------- -------- -- Contra'ctor's Name - -- --- --- ---- Phone _:/- � Installation will serve: Resident Apart ent Hous ❑ Commercial ❑ Trailer ❑ Motel Other ❑ I Nurrmber of living units: _ -_ Number of bedroo ms�_ Number of baths _ Lot size __ �J --��1�---------------------- WaterlSupply: Public system Community system ❑ Private ❑ Depth to Water Table_�?_6'ft. Character of soil to a depth of 3 feet: Sand [``] Gravel ❑ Sandy Loam ❑ Clay Loam[] Clay ❑ Adob Hardpan ❑ Previous Application Made: ~Yes No E] t New Construction: Ye�' No E] FHA/VA: Yes ❑ No_X \ I TYPE OF INSTALLATION AND SPECIFICATIONS: i {No septic tank or'cesspool permitted if public sewer is available within 200 feet.} 1 Septic Tank: Distance from nearest well 'Distance from�ydation_ d__-____Material____ No. of compartments= =-�� --------------Size__ ._, --- ---Liquid depth-------_~7__------ p I ation__-- Distance to nearest lot (ire___-S_______ Dis os 3,Field? .-ID�humberof linese----- welh �--Length of e ch line_.__, ..............Width of trench_______ __--.__-________ t ' Type or filter material,-/*- ---- --------Depth of filter material___-.•�___.__---._Total length__--_-_,__-__�____--_ Sege Pit: Distance'to nearest wel!_ '____Distance from fond ation: d..........Dista e to4,r¢,et-lot -_ ___.._-- _Linin material ______ _�-- ..Size: Diameter. t�n- r------- _-----___ "V �f I Numbe��pifs__:�. f g -� Ceesspool: Distance from nearest wel!________________Distance from foundafion�__--.- --------Lining aterial___----_._--_____________-------___I__ O ❑ � Size: Di6meter------------------- ----- -----------Depth----------------------------------------- --------.Liquid Capacity------------------°---------I s. ry Distance $fom nearest well!-----------------------------------------------Dist,ance from, nearest building-_--_____.__,_______--- r• ❑ Distance to nearest lot line-------------------- ------------------------------------ -------------------------------------- -------- I r Re odelin a ,/or epairmg (describ . ; _ _lr- - --- - ; , ----- -- --------- . --- - - _a---------------------_.__«__.______ice------------------- T------------ y k� C/ I hereby certify that I have prTparedflii application and fhat ftie:workrtwili-be done in accordance-with San'Joaquin County ordinari_ces, a law a rules and regulations of tie San Joaquin~ocal Health District. 1L_ _ _.--[Ow ►td/or Contractor) (Signed} ) - .------ ------- T _ , itle�/�_ -- ------ ` l (Plot plan, showing size of lot, ocation syst in relafio�to wells, buildings, etc., can,be placed on re erse;We). �_. - l/ FOR DEPARTMENT USE ONLY i REVIEWEDON BY---------------------------------------------ACCEPTED BY --------------- ' -- ---- ------- --- -- --- -- --------------------------------- DATE I ------ --- --- ------ --- -1 - - ------------------- DATE - --- -------------- ---------------- BUILDING PERMIT ISSUED----------------------------------- - ----------- --------------- - -- ------ DATE--------- ------- --- - - Alterations and/or - - recommendations:_-------- --/--f -----------f- ------------ - --- - • ---- ------•------------------f-- • --------•-----•----••-------•--------------------- ------------- ------ --- ------------------ --------- ---------- ---- -_ f f/ f) Sy - j ✓� _71- Date - ----_-- . FINAL INSPECTION BY:------'---------- ----- -- - - # SAN JQUIN 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-9-2M Revised 1-57 F,P,CO.