9457 - Laserfiche WebLink

Home Browse Search

- �•-.... �„�_ -��. rte...�.-�r--'s.-...q ` L ✓ APPLICATION FOR SANITATION PERMIT PermU No. -----_---- (Complete in Duplicate) ..y � Date issued � r 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 dinance No. 54 . I' JOB ADDRESS AND OC 10 !, -•------------------- 1„ Owner's Name------- ------------------------------------ ------ =---------'--------- Phone Address -------------- ------------------------------------------------------•--•-----------------------------:..----------------------------------------- Contractor's Name----='--- -= -- ----- --------- ---- -- ----------------------------------------------------------•------------------------ Phone-_-------•-----------..... r Installation will serve:.e Residence A---Apartment House ❑ Commercial ❑ Trailer Court ❑ sM�otel E3 Other ❑ Number of living units:,_.__ Number of bedrooms _;977i Number of baths ---/ Lot size .-..-..,C ,,d _[_ff - _ --------•------------- Water Supply: Public' system Community system ❑ Private 0 Depth to Water Table 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 ❑ No SHA/VA::Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) OeSpft' �ank: . Distance from nearest well........:.. Distance from foundation=__.-__.._.- -___..Material.. --.-..._._--..No. of compartments................ Size Liquid depth ------- --------------Capacity---------------.-•-•--��[ /Number of lines = ...'Distance from foundation_ f Distance'to nearest lot line s osal Field: Distance from nearest well-_--. hen th of each line_..__.. -. 1 9 ��= Width of trench :.' s ! Type of filter material _ _ Depth of filter material.. -;/1 _ length.. -------------------- 7 w page Pit: Distance to nearest well_-.. --Distance r, fosun a+ion---- f ___--. -Is �e to nearest lot line_ See Number of its__../_ _`_________Linin material _/_ S' � �' p 9 �, rze: Diameter - Depth---111414 -- -------- Cesspool: Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining. material............... .._...._-._.._._..Size: Diameter - ------ Liquid Capacity -------- gals. Privy: Distance from nearest.viel------- ____________________Distance from nearest building:---- ---------------------- Distance ....___-------._Distance to-nearest lot line------------------- Remodeling ----- -----Remodeling and/or repairing (describe): ------------- _ --- _ - -- ---•-------- ----------------------•-----------•-------•-•-- E ..................................................................--------........_.__......._.-......----------------------------__-- .............................................................................-_.__.__._...___._...._.__-- ..__-....____-.-.____..-.--___........_....-..._._-_._.._._-..__-..._-..-._...-..-__---------_.__---...___ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County nces, State laws an rules and re lations of he SaniJoaquin acal Health District. , - (Signed)- ----- ---- ----- --------------- ----- ----- ----------' -------- � -,.-,—.-Contractor BY• •: r - + for - - --------(Title)---- --- -.�.�,�..�. ---- - (Plot plan, showing size of lot, Iota+ion'of system in relation t ells, buildings, etc., can be plat Edon -revers e). FOR DEPARTMENTUSE ONLY APPLICATION ACCEPTED BY----- ------------ -------------- -----}-----=-------------=--------- -- ---------------------- DATE------- REVIEWED BY------------------ --- , - = '- DATE BUILDING PERMIT ISSUED--- - ---------------------------------- ----------------------------------- ------------------ MATE. Alterations and/or recommendations --------------------------------------------------------•-------------- •-- ---------------------------------- { ------------------------------------------------------------------------ ---------------------Y � - ..-.._-__... ---._.._ ------------- •--------- ---------------------------- ----------------"' .....------.'-----------..-.-.._.-.------- . .............-_--------__--------------- FINAL INSPECTION BY: ill/ = Date-- t S SAN JOAQUIN LOCAL HEALTWDISTRICT 130 South American Street 300 West Oak Street ` #` r 132 S camore StreetY t 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1.57 17Y.00.