10791 - Laserfiche WebLink

Home Browse Search

xv I APPLICATION FOR SANITATION PERMIT Permit No. (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 application.is made in compliance,with County Ordinance No. 549. 'e,57 Z..14civ L, 44 , JOB ADDRESS AND LOCf1TION=> �-s"�,C _ il%lP�: ZG2�-'t __...P-7-- Owner's Name Phone---------------------------------- Address. f� J� - ' r.• �,1--------- ----- ----•----..�-/----- ---------------------- Contractor's Name: - -q/ ------------=------------------------------------------------- Phone-;-'1`-.•t?--`�41 -7 Installation will serve: Residence F-1 Apartment House [P--Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :1, _ Number of bedrooms _,.Number of bathsLot size__ _(. _., �'S -f_______.__________ Water Supply: Public system [Community system ❑ Private ❑.a Depth to Water Tables ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ©'Hardpan ❑ I Previous Application Made: Yes ❑ No 9--INew Construction: Yes ❑`I�o ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: I s (No septic tank ar'cesspool permitted if public sewer is available within 200 feet.) SepticTank: Distance from nearesf well__ f3' Qistance from foundation---- Q----------Material_e�-j Z, E; --- ------------------------ [0,-, No. of compartments---__...A_____________Size_.JE_K��_______-Liqui-d7depth__y�_____________Capacity.Zq-&- E' Disposal Field: Distance from nearest well_�41 u _.Distance from foundation__ L�__-- ------ to nearest lot line__-__,_.IS^ Number of lines-____-____�_ s. Length of each €ine_____IZ—)_______________Width of trench..__=? _ ------------------- _A . 1 J f JYf •/ Type of filter .material____.____ _ 4__ �--Depth of filter materiaL___,� -----Total length--------/Y1-_ _____________________ Seepage P#: Distance to nearest well-2L R✓____Distance f m foundation___Y40....___,Di tan l�to nearest lot line__.___S___-_.-, JJ�� -fir .- .�, � Number of pits------ -----Lining material__ Jt-d �"_-__-Size: Diameter_ r9___ _-_Depth__..__r _ ____-_.____.. Cesspool: Distance from nearest well____._________Distance from foundation--------------------Lining material--_.-_.______.__________._____ _! I ---------------------- ---------Liquid Capacity---------------------------gals ❑ Size: Diameter Depth Privy: Distance-from nearest well---,--: ______^______ __________ ______.._._Distance from nearest buildin �1 ❑ Distance to nearestY lot line----------------=----------- --------------------------- -- ---------------------•----------------- --- �- -----------------------------' V Remodeling and/or repairing (describe):__._ir�-Ci_ - r ---------A !- 7-- ------------ -------------- ----------- - 1. - - - ------------------- ------------------------------------------------------------------- ------------------------ •--------------••----.----------------------------------------------------- ------ I here car i that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances Stf_eWws, and rules and regulations of the San Joaquin Local Health District. (Signe ----r �--�------ - : - -�--------------------------------------IOwner and/or Contractord�- - - �£-2�--�-� ----- Title (Plotplan, showing size of lot, location of system in relation to wells, buitogs, et 13c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY---- ----------------------------------- ---- ------------------------------------------- DATE---------------------------•- REVIEWED BY - -- DATE---------------------- ----- -•- - -- BUILDING PERMIT ISSUED-------------------------------- - --- -- -- - --------------------------------------------------- DATE---- --•---- ---•------ - -----------••---•A terations and/or recommendations:----------------- ------------------------------• •------------------------------ -------- ---- -- --- ---------------- ---------------------------------- ------------------------------------------------ --- ------------------------ ------------------------------------- -- -- ---------------------------- ------------------------------------------------------------ --= --------- -------------•-•------- ---------------------- --------------------- - ------------•-•-------------------•-••-----•----------_--•----•--•---••------------- ___:_:::_�--t -- -------------- -, -- ------------ - ------------ :::___- --- -- -::__.... FINAL INSPECTION BY.... Date------------- .- ------ -- -- ----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.