14446 - Laserfiche WebLink

Home Browse Search

----------------------------- ------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ..14 '4- _`•f�`^ --------- ----- --- - (Complete in Duplicate) _ This Permit Expires 1 Year From Date Issued Dote issued _.•.`.7"- -_-`- : — Application is hereby made to the San Joaquin Local Health District for a permit to c This application is made in.compliance with County Ordinance No. 549. onstruct and install the work herein described. JOB ADDRESS AND LOCATION__f f y .................Owner's Na Address__ ' " - ----. Phone...r ------- ' �•- -�--�-�----�.�.-��---�--��-.� �-•�--fin - ��--- Contractor's Name__1__ -,l�Q a...._. ..----...••-�..-y.. -�..t -- ---- �-•-------• - - •-•--•--- Phone. .. .�� nstallation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units:__!__-- Number of bedrooms _.Z- Number of baths ___E-__ Lot size' . 7 Water 5uPPIy Public system ❑ Community system ❑ Private De�7clay Wafer Table ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Loam ❑, Clay ❑ Adobe❑ Hardpan ❑ N Previous Application Made: {If yes date----------- -----) No 1� New Construction: Yes f� No ❑ FHA/VA. Yes ❑ No ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-' Distance from nearest Well-----------------Distance from foundation__ YCt-p. No. of compartments--------- -----------Size ------Materiel--- ••.......................:... r � ----------------Liquid depth--- ------CapacityV i Distance from nearest well..-! 1 r __ d`Distance from foundation.._-_.��-____-_-,Distance to nearest lot ingr � ° - k p -_:.. •. �-� Number of lines------- --------------------------Length of each line.--•--- -4_-_--.......... ------_.Width of trench-------•--• -•--- k Type of filter me ferial._-- rc -_----Depth of filter material____./ ------- S----- ----Total length_-------- ------•----- �eepag' It: Distance to nearest well___--J4"—__-}'-_Distance frgm foundation____.t4_�______.Dista a to nearest lot line.___ Number of pits--- ., �r --Lining material_.___l[� --_-Size: Diameter__-___�'- 1.1 Depth_-- D----------- cesspool: Distance from nearest well_ _Distance from foundation___---___ -______- ❑ Size: Diameter-----f_ -Lining material______-- - -•----••-- ----------------------Liquid Capacity _gals. Priv - --------•----•-------"--• Y: Distance from nearest well-------------------------------------------------Distance from nearest building____--___________-_______..___ ❑ Distance to nearest lot line.-_ __._- -------------------------------------- Remodeling and/or r?pairin (describ�} Ik-k � .---- - t� �S f --------------- od �.= �d I ------ ---•---- --•----------•--------------- I hereby certify that I have prepared this application and that the work will be dons in accordance with Sen Joaquin Co ordinances, State laws, and rules and regulations of the San Joaquin local Health District. unty (Signed > ' --• ' ----- ----- ---- ------ By:_ hi�,� (Owner and/or Contractor) or) (Plot plan, showing size oi�lot, location'of system in relation to wells, buildings, etc., can be laced t p on rev' se side). il�i/�• FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. ' REVIEWED BY-------------- ----- # DATES BUILDING PERMIT ISSUED-------------------I--- -------------------- ------------------------ •----- - DATE.----------- -------•--------•---- -•------ Alterations and/or recommendations:. DATE ------ ------ 1 v - ----- - - --- ------- - ----•-------------- i - —--�------ ' �' - FINAL INSPECTION BY:..._ _ --':-.- ----- --------•-------- Date__. ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Sleet Stockton,California Lodi,California 20S West 9th Street { Manteca,California Trat E9 9 REVISED 8•S9 2M 5•61 ATLAS Y,California �