6207 - Laserfiche WebLink

Home Browse Search

SANITATION PERMIT Permit No- - �`-- •------ APPLICATION FOR SA _ (Complete in Duplicate) Date Issued -Y/�"/--� --- a Applica�ion is hereby made to the San'Joaquin Local Health Dice strict a permit to construct and install the workherein described, This application is made in.compliance with County Or ��, r ...r i ---�0--------- - - --'---__-••-- ----------- JOB ADDRESS AND LOCATION__. . _ Z-1 • - 3--- _----------- hone - Owner Is Name-------- .r --------------------------------- ----------•-,-- =--••--------•-------y- ----------- Address--------------------------------------- `----------- --- -- h , Phone -- ----------------------------------------- Contractor's Name_______________ ___ __cv4 . •---- Installation will serve: Residence [�partment House ❑ Commercial ❑ ' Trailer Court ❑ Motel ❑ Other ❑ ` Number of baths _f-•-- Lot size __ .- ------------- Number of living units:F�Number of bedrooms _ community s stem ❑ Private �epth to Water Table 410 ft. Water Supply: Public system ❑ Y Y i Character of soil to a depth o f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ { N o ❑ Previous Application Made: Yes,❑ No �ew Construcfion:'Yes ❑ TYP F INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet) Jl� r y E__Distance from foundation---------------------Material-----____---------------------------------------- Distance from nearest well___:____"___ ---- --- -- ----------------Li uid de p-th-------------------------,Capacity------------------- compartments------ Size- q 1 • sal piston- - ce from nearest wel!_______------------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_..____•--------------- - ------- - �, t.. w� _, Distance to nearest lot line s Seepage Pit: Distance to n crest'wsl!_.�_1!l_ .______ _Distanc f fo ndation_ r g �� --- Size: Diameter. Depth_. pit-s---,/----------------Linin materia ------------ Cesspool: Distance fro Number of • m nearest well-----------------Distance from foundation.__-_._____-:.-----Lining material--------------------------�""---els. p _Li Liquid Ca aci# -------------g El.. Size: Diameter------------------ ------------------ Depth ; q p Y - Privy: Distance froml nearest well'----------------i - ___-__Distance from 'nearest building------------------------------------------ nearest _ ._ __-_ Distance to nearest lot line:------------------- ------------- == - 1 Remodeling and/or repairing (describe):--------- ----------------------------------------------------------- =. , - r ------------ ----- ---•---•-------- ----------•------ ---- •--•--•-------•--------------------------------•----- ----•--------••--- :. * I hereby c ify hat I 'ave,' this application and that the work will be done in accordance---------------------------------------------------------------------------- with San Joaquin County ordinances, St law , anJulnd regulations of the San Joaquin Local Health District. # r - ------------------ o ract C nt or) (Signed...- �_ '~' ---- -(Title)---- By: Titlel---- -- � --it�-- -- - ?� By:------------•--------------------------------------------------------------------- (Piot plan, showing size of lot, location of system in relatio o wells, buildings, et , can be placed on reve.'se side). t 7 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY - --- J-----------------------------------I-- - ----------------------------------------- DATE-, ..... --------------------- ----------------- REVIEWED BY. ----- ---------------------------- DATE---=------------•--------------------------•------- BUILDING PERMIT ISSUED__..___---�`> -:-------------------------------------------------- DATE ---------------- ----------------------- Alterations and/or.recommen ations:_____--_____-"__-_---_ ----------- ------------ - ----------------- --------•---------------------------------------- ------------------------------- ---------•-- -y-------- -------------- - -------------------- -----------------------------•-----•----•- --------- BY ------- - -- = - ----•------------------ -----------------------•--- pate ----••---- ... FINAL INSPECTION�BY--_---Gr'-- ~ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Stree+ 814 North "C" Street 130 South American Street 300 West Oak Street Y Tracy, California Stockton, California Lodi, California Manteca, California Y• FS-9-2M : ' Revised W-2100