10067 - Laserfiche WebLink

Home Browse Search

5 APPLICATION FOR SANITATION PERMIT Permit No. Applicatio (Complete in Duplicate) /--------- - r, Date issued __�!_-a-•J/�S d n is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de This application is made in compliance with County Ordinance No. 549, scribed. JOB ADDRESS AND LOCATION_________L_ Owner's Name------- - -------------------------------------- Address -- ------- ---------- ------- -------------- ----- ------- --------------------------------------------- Phone-- -- --- 7 Address--------------4aa- -- --------- ----- ----- ----------•---- ---- Contractor's Name-- --------------�-�; - Phone. �. Installation will serve: Residence _ l-5' hpartment House ❑ Commercial ❑ Trailer Court iii Number of living units: _�-__ umber of bedrooms _-YN ❑ Motel ❑ Other ❑ umber of baths __ __-__ Lot size To-�___--__ __ Water Supply: Public system Communit system J [i Y Y Private ❑ Depth to Water Table _______ ft, Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: Yes 0 No New ❑ '°`dobe Hardpan ❑ p Construction: YeFHA/VA: TYPE OF INSTALLATION AND SPECIFICATIONS: s ❑ No [] Yes ❑ No LLQ i (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) (fePtic Distance from nearest well-----------------Distance from foundation______-__._______.Material_____.____-___.____--_o. of compartments ---- -- ------Size------- --- ----- ti ,,.. Liquid depth -----------Capacity------ - ------ sal Pie Distance from nearest well Distance fror`n`,foundation_____-_______-___-.Distance to nearest lot line_________________ Number of lines- --•-------------------------------Length of each line------------------------------Width of french ----------------- Type of filter material '___ `_ -__Depth of filter material___.__-._____ -._ See a e (( Total length---__---- --'_----- -_- - -- p g Distance to nearest wel ----- 0' ' nce 1f ___Distance from` oundation__ 0--------_.Distance to nearest lot s_.- Number of pits--_I✓_______________!?Lrning material___ W _________ _____Size: Diameter_;$'k Cesspool: -----Depth -- -- ----- .0 .p Distance from nearest wel_I_____ ------- _Distance from foundation________.___- ❑ Size: Diameter ----Depth-- -- f -- ---.Lining material----------- --- Priv : + Liquid Capacity= ------- -----gals. Y Distance from nearestowel{__ _ - Distance from nearest building-___------------- Distance to nearest lot line?- +---------- --- Remodeling and%or repairing [describe):__ (� _ ,p a ---- �` . / -------------------- -- - ------------------------__ ________ _______-----_-___ -----------------------------------------________ - hereb ------------ ------------------------------------------------------------------------------------------- ---------------------- -------f------------------------------ W f II ---------- -- ----=--------------° y certify that I have prepared this application and that the work will be done in'accordance with San Joaquin County ordinances, State laws, and rules an regulations of the San Joaqui cal Health District. :; ` (Signe r My - ----- ' - Contractor) (Plot plan, showing size of lot, location of system in.relation to a buildings, et , an beleplaced on reverse side). FOR DEP R ENT USE ONLY APPLICATION ACCEPTED BY-__- __ ---------- -- - - -- ---- -------------------------- --------------------- DATE REVIEWED BY- -- -------------------- ------- ------�- BUILDING PERMIT ISSUED----------------------------------------------------------------- DATE •�- ---------------------------------- -------------------------- --- ----------- DATE Alterations and/or recommendations: _____ --- w�� -------------------------------------------------------------- •-------- ------------------------- ---------------------------4------------------------------ ---------------------------------------------------------- -------- -- ------------------- ----------------------------------------- FINAL INSPECTION BY_______ -------- __ �.. ----------------------------------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT Stock+on, California 13D south American Street 3D0 Wast Oak Street 132 Sycamore Street 814 North "C" S}reef Lodi, California Manteca, California Tracy, California ES-9---2M . Revised 1-57 F.P.CO. II