5050 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ............. (Complete,in Duplicate) Date Issued .. --------'� Applica4-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 in compliance with County Ordinance No. 549. f - - 4�.•�. v . „ E --------------------------------- JOB ADDRESS AND LOCATION---------------- one-------- -----------••------- k ------------------ --- P-------------OwnersName------------=--------- ------------ -------------- ---- ----------- ------ ----------------------------- - - ---• ------•---•----------------•--- Address---------------------- Contractor's Name ----------------•- ------ Installation will serve: `Residence Apartment House [j� Commercial-❑ Trailer Court El Motel E] Other El Number of living units: _r_-.. Number of bedrooms ._.i ^umber.of baths -_. Lot size ------------ --- -----------•-• 'r z Water Supply: Publicsystem-�ommunity.systerri ❑ Private [I Depth to Wafer Table ---------ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] 'Clay Laamt❑ Clay El Adobe ardpan F1 Previous Application Made: Yes.2�t o ❑ New Construction: YestR?_l o El { { . TYPEs OF INSTALLATION AND SPEC]FICATION5: +- - 4_ ,. (No septic tank or cesspool permitted if pu is sewerisavailabld withint20Q feet.)Or Material..- - . Septic Tank: Distance from nearest well- ..- Dist 'nce rom fc ndafi .. - -- No of compartments------.- ` ' ----Size_ ,K f `iquid depth--.----- ------Capacity-_- _L-�-- 1 i 1 - 4 .7 }/_ .... Distance to nearest to line...`! f Disposal Field: Distance from nearest wel .._077 �_Distance from foundation... 9 4d"4 of trench Number of.lines------ ------------------Len th of each line.__ _ Total length--:. Seepa e.Pit: : Dysa of enea estlwlell_��.7 _..__-AD stan of fromfoundation....................Distance to nearest lot line...._._._.-..--. ` 9 ❑ Number of pits--------- ------------>-ming material------------------t_ Size: Diameter----•- ----------------Depth-------------------•------ ----- Cesspools Distance from nearest well----.... Distance from foundation-- ------ .._ Linin material.... ------------------------------- Cesspool: .... ........ ._....__._.. Depth------------------------ - -•_> . . . q. Capacity_ _ ` -- e:TDiaeter' _S" .. _p A_Y - ---------------"-•gals. ___.._..Distance from n.earestlbu � � Distance from nearest well------ -------- ------ ilding-----------------------•-•-----•--- Privy _ m ❑ - -'Distance'to'nearesf°lot-iine.�'" "� T-�- 'µ 4m .................. ----------------------------------------_.........-_--- i t Remod6n and/or re airing (describe):---------- -- ----------------------------------------"---------••------- -"--------------•--------------------•-•----• l i f F --'------------------------------------- - . , y . t .... ---- •-_...__ ---------- - ------------ i i ,-. - IIhereby,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 and regulation's of-the San Joaquin.Local Health District, t �l F t ------ (Owner and/or Contractor) (Signed) r or r / �' -- - -F------------ ---•-----_----_----------------_-=--[Title)------------------ BY -------------- '�n of system in relation to wells,'Virildings, etc., can be placed on reverse side). (Plot plan 1 shawing '.i. Y kkk FOR DEPARTMENT USE ONLY . 1 1--.I------------------------ ------------ J APPLICATION. ACCEPTED BY---------- - -------------------------�--------- •----- DATE----------- -------= ------- --- ------------- REVI EW ED BY-.---,. --------------•---- ------•--------- ------------ DATI, - - ---...: 1 -. l ' BUILDINGPERMIT ISSUED--------------------------------------------------------- --------------------_------------- . DATE = Alterations and/or.recommendations------------------- -----------=---=---•--------- • -•-------•- -------- ------------------------------------- 4 rI ----------- -------------------------------------------------- ------------- �. F I ! . .... FINAL INSPECTION - ""-. -- "--• -- --- �-----------------------• ---=--- •--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100