5904 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. Date Issued ____ix-, Applica}ion 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 incompliance with County Ordinance No. 549. �( ©� q 4 .--------- -----•-•••------•----------------- JOB ADDRESS AND LOCAIIN,,.,_.�- rJ--- ' Owner's Name :•-•-----------------L4 W -11,L1 ---------------- Phone Address--------- •-•-••.-••----------------- --- ------------------ � Phone �� Contractor's Name - -- Installation will serve: Residence Apartment House [3Commercial E]Trailer Court ❑ Motel ❑ Other ❑ _ ----- Lot size -4Z;". �--�- `--��=�- -�-------------•- Number of living units: --- _� N mber of bedrooms __ _ Number of baths .� Water Supply: Public'sysfem � Community system'❑ Private ❑ Depth to Water Table ft. 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se rr is aavvagiable within 200 feet.) �► Distance from nearest well,�3A-------- Distance from foundation ------------------- _Material ------------------------------ .-_____._---_____.. No`. of compartments--------- - �e----------------Liquid depth -------------------------- Capacity --------- ------ �..1.- ' Disposal Fi Distance from nearest well_ -d_-_ --- ..._.Liistance from foundation__/ ------_ Dist ance to nearest lot line -___0____.- Number of lines ---- -t------- - --------------Length of each line_--d�-----------•--- Width of french-_ -- ------------------ lIfy Diepth of filter material----/ r--------Totallength-.------ �-V•---------------------- Type of filter material "� -�--• // ___Distance fr foundation__J-P:---Distance to nearestlot line ---- I_d___._ Seepage Distance to nearest we!! -fit ---- � ---Size: Diameter-- ..4_._ -__De th------Number of pits---1-----------Lining material--- ------------ �- p. ------'�!If Cesspool: Distance from nearest well_________________Distance from foundation____________._..__.Lining material__.________------- aIs. ❑ Size: Diameter--------- -------------- -Depth----------------------------------------------------Liquid Capacity-- -------------------9 Privy:. Distance from nearest well-__. --------------------------------------------- Distance from nearest building ------------------------------------------ Distance to nearest lot line_-=----=------------------------------------------•-----••-----• - - Remodeling and/or repairing (describe)------------------------"------- --------------•------•--•----•------•-•-------------------------------•------. ----------------------------------------- -------------- --- •-•--- •-------------- ------ --- ----------------------------------------------------------------------------------•-----•----------•---- I herebrtify-that I have prepared this application and that the work will be done in accordance with San Joaquin County W-qordinancesV.Stalaws, and rules and regulations of the San Joaquin Loc I Health District. .___-E)rrd�lef Contractor) (Signed) ----- ------ _/ -----_--------- (Plot ---_----•--- tTitle) 1mt �-C�,1 (Pllot plan, showing size of lot, location of system in tion X;iowels, buildings, etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ ________________________ ---................---=----------- = DATE •----------- --------------------•- i. DATE--- x ------...---•------------------------------------- REVIEWEDBY ----------------------------- ------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------=---------------------------------------------------- i .DATE.. - Alterations and%or_recommendations------------------ '` .---------€. •--jq ----•--- y --� � I.fit V- � k ( ) "----------------------------------------------------------- ----------- ---------- �-------- � / _ -------- ------ 4) El :? I---------------------------------------------------- ---------------- ------- =_ \� FINAL INSPECTION -BY:- --------- ----- ------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y, ES -9-2M ; Revised W-2100 WE