8634 - Laserfiche WebLink

Home Browse Search

X APPLICATION FOR SANITATION PERMIT Permit No. .__a � .r . (Complete in Duplicate) a F l ;I Date issued Application is hereby made top 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 Ordinanck4No. 549. JOBADDRESS AND fLOCATION-------------------- -------------------- - -`-------?° ------------------------------------------------------ ------------------------..---- ------- Owner's Name------- : t�.i _ __2-11J- _ Phone---------------_----------------- Address--------=--------S t-�-- ---------------------------------.-.-------------- --- ------------------------------------------------------------------------ --------- ---------------- Contractor's Name__,-- � ti @tet ------------------------------------------- ----------------- -- --------------------------- Phone.... Installation will serve: ° Residence Apartment House ❑, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numb��r of living units: _/.... Number of bedrooms ___/___ Number of baths __ ---- Lot size _--- _moi__ _____ _y__________________ e Water Supply: Public''system`K Community system E-1Private E] Depth to'Water Table --------Ift. ' Character of'soil to a depth of 3 feet: Sand l] Gravel ❑ San y Loam F71 Clay Loam E] Clay ❑ 'Adobe+, Hardpan ❑ Previous Application Made: Yes ❑- No New Construction: Yes No ❑ FHA/VA: Yes ❑ ,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) Q ' Septic Tank: s Distance from nearest well-)0+0____._Distance from foundation-1L_______.____.Material_ _5,%-N__ __ i, No. of compartments-_-�---------------Size_-S_y►_ � - ._--Liquid clepth----- ------.-------:-Capacity_-• [?- --_-.__-- Disposal Field: Distance from nearest we+.q_ __"h1..-_Distance from foundation-----I(a----------Distance to nearest lot line._2.._._..... i; Number of lines-----_- ____ Length� of each line_ -----of trench f Number `jR•� _ C9f filter material _'_-7---._____Total, length____jyb______ ,�, Type of filter materia!_ ___ _ --------------------------- 0 Seepage Pit:,' Distance to nearest,well______________________Distance from foundation--------------------Distance to nearest lot line-------._____._._ ❑ '6 Number of pits----------------------Lining material-------°---- ------_.Size: Diameter----.------------------Depth--------------------------------- El Cesspool: Distance from nearest well------------------Distance from foundation-------------------.Lining material-----------------------_____._________ ❑ Size: Diameter---------------------------------------_Depth--------------. --_--=__ ! =Liquid-Capacity _:"__-gals. Privy: r' Distance from nearest well �_�'-_k-- ___._ _ ._Distance from nearest building-------- �1_____. Distance to nearest lot line _ - -------------------- --------------- _. Remodeling 'and/or repairing cri6el: ------ -----e - -- -- .. ...... ....... . --- ---•' � --' ----- - ----------------- -------------------- ------------ - ------- --=----------- -------------------------- --------------------- - I hereby certify that I have prepared this applicati n 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 !/-!_ -_ rr- ^` - "" ------------------------------------------------------ ------.(Owner and/or Contractor) 6 a (Plot plan, showing size of lot, location of system in relation to wells„ buildings, etc., can be placed on reverse side). 4 ti FOR DEPARTMENT USE ONLY ACCEPTED BY---------------------- '.---------------------- DATE ----------------------------- APPLICATION REVIEWEDBY-------------=-------------------'--------------<- ---�------ ------------------------ --------=------------------. DATE. ". 6 BUILDING PERMIT ISSUED------------------------------- -- ------------------=-------------------------------- DATE------------ ---------- -- - ---- '�- --- •---- Alterations and/or..recommendati ns: ------------ -t---�--- i---- , - � .-� ---------------- --------- - 5 --- -- ------ --- --- --- - ____________________________________________--c________-________._____-_-------_____.-________.__.__._T____.________-.__.___-..____._______.._____._-____________ - 7-------------��)�1 ��---- ---- ��-�------?�� '�=�' --------- i��'r!�c�.�/�d/ ��'-�� FINAL INSPECTION BY--------------- -�_'�rAIZ e�------•-------------=-- Date------------9:-:7 T ------ -- - I ---------------- /SAN JOAQUIN LOCALOHEALTH DISTRICT 130 South American Street 300 West Qak Street 132 Sycamore Street 814 North "C" Street Stockion, California Lodi, California Manteca, California Tracy, California y 6 r ES-9-2M Revisoa 1-57 F.P-M