10323 - Laserfiche WebLink

Home Browse Search

14 �� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ) ��b/ 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. JOB ADDRESS AND ,LOCATIQ� ....-�. la__. r ✓. _;, I - ---------_J ------------- 91 Owner's Name ~R�) " f! - '------------------------------------------ - -------------------------------- Phone_ Address-------------------------------------• "` -- ---------------�-------------------------------------------------------• - - ------------ ....... Contractor's Name---------------------- •_- f;;�_____` - :Phone.' ; ,- ---- --------------------- ` Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other E] Number of living units: ___I Number of bedrooms __ Number of baths __-- Lot size ------- ------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table RC1 ft. Character of soil to a depth of 3"feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes (] No New Construction: Yes E] No� FHA/VA: Yes E] No* TYPE OF INSTALLATION AND SPECIFf TIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ApDistance from nearest well-_______________Distance from foundation--------------------Material ____-____._____.__._._________________________... No. of compartments------------- ------}Size-------------�•---- r -'Liquid depth--------------------------Capacity-•-•------ --- -------- Dis os Distance from nearest well-----------------Distance from foundation._`L_-___________.Distance to nearest lot line______...________ 40 Number of lines-----------------------------------Length of each line-------------------------------------------Width of trench----------------------------------- [_ X Type of filter material-__________ ____________Depth of filter material___- --_-_-_________.Total length_----------____-____--____________----.__ r � Se a e Pit: Distance to nearest well______ _r5_ll --Distance fromfou ation_ ._l� _._..Distance oto nearest lot line__ —r._. Number of pits-------- ------------Lining materriaAl�----� scsize: Diameter-------= ------.Depth- - --------- I Ce s oal: Distance from nearest well----------E------Distance�'from foundation_I----------------_Cining material-------_______..____.______.________.. Size: Diameter------------------------------ `--- -Depth-----+-#------- --------------- -----------------Liquid Capacity----------------------------gals. Distance to nearest lot Ione 6 from nearest building Privy: Distance from nearest weft------------- ---------------�-------"�--Distance f --- t building -------------------------------------- '4�\ % ,ice Remodeling and/or repairing (describe): �•• - --- ----- - ' ---- 'mow y ---- ----- - -------•--------------------- --,---- a ! hereby certify that ! have prep d this application and that the work wile done in accordance with San Joaquin County ordinances, State laws, and rules a r gul I idns o�*ha;>San Joaquin Local Health#District. (Signed)---------------------------------- - G- --- ------ --•--- r-----=--- Owner �and/or Contractor) 1 �^ BY: -- ----•------------------ ------------------------------- -------(Title)----------- --- (Plot plan, showing size of lot, location of system in relation to Is, buildings, etc.; can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By-(-; -------------'--------------------------- -----•---•-------------- DATE-=_ REVIEWEDBY------------------------------- - -------i----------------------------------------------------------------,-------- DATE--�---------------------------•--------------------•- BUILDING PERMIT ISSUED-,......... -------------------------------------------------------------------------- ------ DATE---- ------------------------------------- - ---------- Alterations and/or recommendations:--. !- ' --- recommendations:__._______ _____ ! - ---------•-------- -------------------------------- --------•------------ - C --- -•------------------------ ----------- --- - ` ------------------------- -------- ---------------- ----------------- --------------------------------------------------------------------------------- ------- --------------------------------------------------------------------------------- ------------------------------------------- FINAL INSPECTION ---- Date) ----------------------------------------------------- SAN ----------------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Street 814 Norfh "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F.P.CO. r