5042 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. I .-��' �4 (Complete in Duplicate) y 1 Date Issued A fica{ion-is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. PP Y q This application is made in compliance with County Ordinances No. 549. JOB ADDRESS ANDLOCATION_ p kDs -------------------------••---••-- - ----------------------- Owner's Name--------------LQ4_�.S�---- a i1•-6i�� ------�. I--�► / A/y -----'-703.4"'a--J! Phone Q Address-----------•----------------------------------_Ix..1 -------tgp_t l+�►_It1��»�.� ------------------- --•-----•---------•---------- --------------------••------_----_-------•--- Contractor's Name------ ---•-------------------- ------ -------- -,c. .............----------------------------------- Phone"@_- -" Y-6-- ? Installation will serve: Residence 51 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms J-: Number of baths _/.._ Lot size _ �_"~-. __ _�-Q _________________ Water Supply: Public:system X Community system El- Private'[-] 'Depth to Water Table _ __Oft.— Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: Yes ❑ No5jC New Construction: Yes 4 No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well_Aa%>I6-_Distance from found _ation_ 0.----.-_--Material_______ ------------- --------------- No—of compartments--_Z ------------ Liquid depth---s`7E. --------C a p a c i ty._00AV N �V Disposal Field: Distance from nearest well_ Q1[C_Dist ncee from o elation___-1 Distance to nearest lot line.--wT--�.__. Number of lines___'_ ------------p�*�---t__-'-__Length of each line__ �____ Width of trench- �Gr-__ -- a � r .. ''�" Type or filter material-----�_Rir__ _._._Depth of filter material.._.-_- _______Total length-A- , ---!-__-____-_-___--____ Seepage Pit: Distance to nearest well-tu- -'----Distance from'foundation---- __-:Distance'to nearest lot line__,«_._ Number of pits----I----------------Lining mate ria lodfiqA___-Size: Diameter-;5-3-°i______Depth__,Z +- Cesspool: Distance from nearest well-----------------Distance from fou4ddtion--------------------Lining material------------------------- ------------ El Size: Diameter_________________________________�__De th a _.______L's uid Ca acit Privy:: Distance from nearest well---_---_-------------------------------------------Distance from nearest building___._.--________._:__________.._____----- ❑ Distance to nearesfi.lot line ------------ ----------------------- --- -------- -------------•---------------------------------------- 1 l Remodeling and/or repairing (describe):-------------------------------------------------------------------------•--•--------•----------• -------•--------------------------•------•-----•-------- ---------------•-------•------------•-------------------------------------------....----------------------------------------------------------------------------------------------•----------------------------------------- ------------•-------•-------------------•--._-_._-_.•._..--------------•---------------....---------------------------•--------•--------------------------- I hereby As, that-I have pr pared this application and that the work will be done in accordance with San Joaquin County ordinsnce5, 5t and rulesd reguia ' ns of the San Joaquin Local Health District. (Signed} j� � = �� ' --------- ----------- --------- p` ' Contractor) B •-••- [Title} _A t 50--- 0---` Y---•---------- - ------- ----- (Plot pian, sh-owing size of lot, location of syst m in rel n to w s, buildi S, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---•-----------------DATE------ ' ' a� � { REVIEWEDBY----------------------------------------- -------- ----------------------- - ----------------------------------- DATE------ ---- ----------- •--------_--I --------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------- -------------------------------- Alterations and/or recommendations-------------------------- -----------------------------------:-----------=! ------------------------------------------------------------------------------------------------------ ------•-•--------------------------------------------------------------------------------------------------------- -----•----•--------------- ----------------------------------------------.-------------------- ----------------------------------------------------------------------------------------------------------------------------- F F -------------------------_---------------------.-----------------.__------------.--------------.----------------------------------------------------------------- FINAL INSPECTION-BY:: _ -= � �- bate - _---- ' r - ------------------- ------------------------------ 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