14043 - Laserfiche WebLink

Home Browse Search

4'� -07 _ 3- 3 -.---------�s_ APPLICATION FOR SANITATION PERMIT Permit No. .�...4.. ..3 ----------------------------------- ------------------ (complete in Duplicate) ---------- - ------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to.construct and install th wor This application is made in compliance with County Ordinance NP. 549. e k herein described. -•�J JOB ADDRESS A CATI N._____..._CJ�- t -- -•--- ---�•f-------•- .- Owner's Name-------- ---------------- .. . -_ .! -• ------•-------•-- �---- -- --- -_----------_ Phone.................................... Address.-.24 -- -• . ............. ............................................................... Contractor's Name__._...--- i l --- ------------------------- •---•--- _--- ......._ Phone. Installation will serve: Residence Apartment House I P ❑i Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __/_ Number of bedrooms i s�-. Number of baths _�t;Lot size ----- O-•--.�-•l�� ___ _, Water Supply: Public system[ Community'system 0 Private ❑ Depth to Water Table'_t�._� ft. Character of soil to aldepff of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clo Loam Clay y ❑ Adobe Hardpan❑ Previous Application Made: (If yes,date____________________� No g3--'—New Construction---',Yes No W3 - Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS: i+ " (No septic tank or cesspool permitted if public sewer is available within 200.-4et.) is :+ Distance from nearest well_________________Distance from foundations + ------_ Materia l---•-------•----No. of compartment ---- ........................SizeI----------•-------•-------. quid depth ___-.__-_-_ - Capacity................------- Distance from nearest well______________-__Dist ance from foundation_ __Distance to nearest lot line.:............... Number of lines------------------------------------Length of each line--------------------------.'_.Width of french.__...-----_____------ Type of filter material---------------------- Depth of filter material---- _-__---_----..'Total length.----_-------- Seepage Pit: Distance to nearest weld t Distan ndation___ -Q-_.-_,.Distance to nearest lot line----- ... Upo I\lumber of pits------L._____--___Lining rriate�ial��_Tf7 . Size: Diameter. _�.- --__-___-Depth__,R.. '----------------- D ------- ------ \ Cesspool: Distance from nearest well------------_ Distance from foundation..------------------Lining material_________________________ ❑ Size:-Diameter--------------------------------------Depth---------------.------------------------- ------------Liquid Capacity------------------ .........gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- Distance to nearest lot line -_ _ �� ---�`t Remodeling and/or repairing (describe)______________________________ I f -------- ------------ ------- i ---------------------------------------------------------- I"' ---- - --•-- -•• ---------------- ---------------------•---------------------------------------------------- ------------------------------------------L i ">. + 'd. 9 i i R , I herebyy7afelaws at I have prepared this application and that the work will,6e done in accordance with San Joaquin County ordinances. 5and rules and regulations of the San Joaquin Local HealthDistrict. (Signed).......... .....:. . ... . ... -----------------(Owner and/or Contractor) By:.................-•••....•.�..... - ••------••-- - -------•--------(Title)---------- ••------------------------------------ {Plot plan, showing size of'lot, location of system in rel 0 wells, buildings, etc., can be placed on reverse side). 3 1 FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY ,.,r..�----------------------- -------. DATE - -7. REVIEWED BY ------------'f------- - --------------------------------------------------- - ------ . DATE.__.- --•--------------•------••------------ UILDING PERMIT ISSUEDA E-------------- _----• _ Alterations and/or recommendations:_.-„.--_.3.v ------ - ---------- -------------•--------------••----••-•-------•-- •- ----------- ----- .--------•------•-----• --------- .... .. --••-------•------ •---------------- ----------------• FfNAL INSPECTION BY:.__ i• .! _. Date---- ••-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sirpt i3' 144 Sycamore Street Stockton,California '; 405 Wes}9th arse! Lodi,California � '�j Manteca,California Tracy,California Er. 9 REVISED 8.89 YM 6-61 ATLAS • , .