10935 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR„SANITATION PERMIT Permit No. {Complete in Duplicate) y Date Issued ----- Application ___Application is hereby made to the San Joaqui -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. 1 ti JOB AN LOCATION. r - -- - i---- �"_if Owner's Marne_-, : . ` .4 ...� ------ - Phone Address--_/,.d,---- ------ --- 7 3 - Cont� i et Phone. Installationwill serve: ' Residence ❑ AP tme nt House ❑ Commercial ❑ Trailer Court Motel Other ❑ ` Number of living units: _.t Number of;bedrooms _?__ Number of baths - __ Lot size ---/�10-- / -Q--------- -------`-------- Water Supply: Public system Communitytsysfem� ❑ Private ❑ Depth to Water Table 0 < ft. .,..-.,...,.,.,.. Chard ctg of sail to a depth of 3 feeft`� and.❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe [ ' Hardpan ❑ Previous,Application Mad Yes ❑€No New Construction: Yes No ElFHA/VA: Yes ❑ No) ,J • r -AoTYPES OF INSTALLATION%AND SPECIFICATIONS: (No,sep'tic j�ynk.or;ce.sspool permitted if public sewer is available within 200 feet.) Serfc Tank:. Distance from nearest well-!---------------Distance'from foundation--------------------Material_________________________________________________ .., ._ No. of compartments.--------- - ---Size---------------------I--• ----Liquid depth------------------ ---- Capacity----------------------- A A Dispos Field: Distance+from nearest we€€-----------------Distance from foundation.4-----------------Distance to nearest lot line________________- ' Number of lines----- -----------------------------Length of each line--------------------------------Width of trench w---�,_-`--s---1-,,-----_------ # Type'�oflfilter material_________________________Depth of filter =af aria)__________:__`____-__Total length___-__________ � ----------- Seepage Pit: Distance to nearest well_ -----Distance from f undation_AP__+_.___.Distance to nearest lot line____--___- I Number of pits___ _______________Lining�m�aterial,, ------Size: Diameter__y _�--------Depth----- f_-__________-_\ Cesspool Distance from nea'rest well-------�1___'Distance from foundation___``---------------Lining material-------------------------------------- U _________________ ____.❑ Size: Diameter---- -------------------=T� Depth-- "-,-_--:----t---_----------------------------Liquid Capacity-_-------------------------gals +"E Privy Distance from nearest well--------------- ----------------------------- ___Distance from nearest building----------------------------------------- .Distance to nearest lot line------------- r -------------------------_----- ------------- Remodeling and/or repairing -- I---=:------------------------ ----------•- --- ----- ------------------------_f-__---------- ---------- -----------t-- + . I ' _ I�hereby certify that I have prepared this application and that the work will be done in,accard'ance'wdfN ,an Joaquin County r ordinances, State laws, and rules nd-,reg ations f fhe an Joaquin Local,Health District: ' (Signed- -- ----------- - -------------'------------------------------ -------(Owner d/or ontrtor) $Y: ---- - - ---------------- -------------------------------------------------(Title - t IN (Plot plan, shtowing s' a lot, location of system in.relation to wells, buildings, etc., can be placed°,on revers ide). V FOR15EPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---------- ---------------------------------------- DATE------ -' -- `J�-•-------------+--.,,-- REVIEWEDBY--------------------------------- --- -----------------y---- j''� ------------------------- DATE----------------------------------------------------------- - BUILDWG PERMIT ISSUED---------------------------------- -------N.... _?!7�------ ------ SSUED --`--- =-------------------------------------- _ DATE = == =� Y. _, ------------------------- Alterations ------------------------- Alterations and/or recommendations:__._______________________ 'I_ __-_____ _--- F I --------------------------•-----------------------•---------------`------------------ - ------r----•---------- -- _..-- ----- --- .__- ------------- _ --- l -----•- -- -- .r • .- , 67 �- --- --- ----------------------- --------------- Ae r A�L „ FINAL INSPECTION BY:------ -------- Date-------------------------- -------------- -------------------------- SAN JOAQUIN CAL 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 Revisea 1.57 F.P CO.