9494 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ______________________•- (Complete in Duplica+e) Date Issued .r� v�-'--- Application is hereby made to the Sain Joaquin Local Health District for a permit to constructed install the Ale work herein described. This application is made in compliance with County Ordinance No. 544. �a /ate��t / f. .f - ._ 470 `' _ lig_ -i`/- A-40---------------------------------------------- JOB ADDRESS AND LOCATI N_______._ - - --` F r Phone_TU rj----��.. Owner's Name --- Address----------------- -•----------------------------- =- --- -- _ ---•-- Phone--------------- Contractor`s Name--------------------------- Installation will serve: 'Residence Apartment House F] Commercial (DTrail r Court ❑ Motel E] Other [I ; II �3 ---- Number of living units: __-f--_ Number of bedrooms ___- _ Number of baths ___yc Lot size Community system Private'❑ Depth•to Water Table -------- ft. Water Supply:..Public system F1 Character of'soil to a depth of 3-:feet: : Sand 0 .Gravel ❑ Sandy Loam ❑ Clay LoanX Clay ❑ Adobe❑ Hardpan ❑ Yes E] No ❑ FHA/VA: Yes E] No El Previous Application Made: Yes E] No ❑ New Construction: TYPE OF INSTALLATION-AND SPECIFICATIONS: , 1 r _ (No septic tank-er`cesspool permitted,if,public sewer is available within 200 feet.).:-;_ — _ -- - - � ,aer Septic Tank: Distance from•nearesr well___ _ xDistance-from foundation___ _____ -------- /r�-------- CGZi- Sie `-- .Liquid depth--------- _ Capacity --- --No. of compartments----`- ------------- _m -.- -- - --- istance to nearest lot line_________-------- D _______ Disposal Field: Distance from nearest well.,.' -.Distance D s anh of reach line foundation---_ , . ;�q-t(. Length -� ','Width of tren� ------ Number of lines________- 9 ..� , ' Type of filter material---- ��`l'" ----Depth,of filter materia4--------r _Total4ength__ _ = '- ` Distance.from foundation___: "" �lstance-to nearest lot lime__ Seepage Pit: Distance to nearest well = _ .� __ ---------------------------------- Si -- r------ --- --------- ❑ Number of pifs_. 4j �- Lining material__ctSize: Diameter ,{ Depth Cesspool: Distance,from nearest well___ ____________Distance from foundation .- _ - _.-___.Lining material_ :______-__. Size Diameter-- --- ---------[Depth-T---- - - -_I.--Distance from -----Liquid Capacity------------ gals. ❑ - ` ! w Privy: Distance from nearest well------- ------------------------ nearest building---- .---•---------•--------'----------- " . --- ---------------- ❑ _..« _Distance-to nearest lot line_. . =` -- - -=--------- ------ ----------- A _.: - ---- __._.. --- Remodeling and/or repairing (describe):_-_____-___________________________ ____ ___------------------# � � __ --- y = = -_ --- ----------------=- -----------•------ s ---- - ---.. i, k ______ ______ ______-------------_----___.___-._______ --- ! hereby certify +he+ l have prepared this application and +hat the work will be done,in accordance-with San Joaquin county District.- ordinances, Stat ws, and r s and .regulations of,fhe San Joaquin Local Health Dis+ric : s 1 I ' (Owner and/or Contractor] (Signed -- = e (Title]'4. -- (Plot plan, showing size of lot, Iota+ion of system in relation to wells; buildings, a+c., can be placed on reverse side]. s FOR DEPARTMENT.USE ONLY `. '� .k ► . . - -----------=-,DATE----`-----� -- -- --- --- i, APPLICATION ACCEPTED BY------ - ,� TE = _ 4 --- --------- -------• DATE--------------- -----------------------•-------------------- 75 -_ ------------. 4 BUILDING PERMIT ISSUED--------------=------- s REVIEWED ----------------------------- " � _ Alt ra,+t�ion and/or ecammendations:___-___-- �'�T� ___________ __ ______ _ _ ____._ ____ -___-_ _ ' _ - f - '. ' -------- ' ----------------------- --- --'- ..___...__---'------------•---•-------------'-cam --------'-�-'-----------------'-'-- FINAL -INSPECTION, BY:" __ Date:_-- -- - -------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street $14 North "C' 5tr�eet 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. Revised 1,757 F.P.00.