5843 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued/_Z t _.66 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 in compliance wit ry�Orainance No. Z"� JOB ADDRESS AND LOC (ION Owne Na Address---...----- It r'�, -------- Contractor's Name---------- ----- •- ----- ---- T ' --------------------------•--- Phone- -----_--- -------...-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ MSI ❑ Other ❑ Number of living units: __ember of bedrooms .... Number of baths ._i-_-- Lot size ... ._�._f�_._- ..... hab............ I---- Water Supply: 'Public systemCommunity system E]Private E]Depth to*Water Table -------- ft. Character of soil to a depth of �3eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Application Made: Yes ❑ No New Construction: Yes ❑ No&Rr-11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _�2pfic Tani:, Distance from nearest well ------------------ Distance from foundation -------------------- Material --------------------- ._.._ ..... E ty /5 No. of compartments ------ .. ------------------- Size ................................ Liquid depth -------------------------- Capacity Dispos I F• Id: D' tante from nearest well %fil�istance from foundation.l_Q__._.._._.Distance to nearest lot line S7(- umber of lines-__--.-._._. L th of ach line Width of french..--. / a h 'fit.. f----— -- ---------- C ---- Type of filter material_5 4_CD (&AGt r matenal___._/.,7_--_-___Total length_._.._. ..( �.---------------- P, Seepage Pit: Distance to nearest well _. _ ___-- __ _Distance from foundation....................Distance to nearest lot line ❑ Number of pits -------------- _ ------- Lining material .......................Size: Diameter -------_---- -------- Depth --------------------------------- Cesspool: _-_--._. --.-_.--- _--__---.Cesspool• Distance from nearest well_________ ______Distance from foundation -------------------- Lining material ...__-__-_.__._--_-- ___._....... 14 ❑ Size: Diameter--------------------------------------- Depth ---------------------------------------------------- Liquid Capacity. • ................. 44.gals. Privy: Distance from nearest weil-----------------------------------------------___Distance from nearest building ------------------------------- ❑ Distance to nearest lot line ::--_.:_-: �— d ,..9 ` %.&. n 1,. J + ---------------------------•--•-----------•----•-------•-•--•----•-------•--••--......---••-............... ---------------------------------------------------------------•-----------------------•------------------------- I hereby certify that I have prepared this application and that the work wifl be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) t! .----- ----------------------------- ----------------------------------------- (Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _------------------- ---------------------------------------------------------------- DATE "' REVIEWED BY --------- --=-------------------------------- •------------ DATE ------��i----------------•--------------•-------- BUILDING PERMIT ISSUED___--_--_____- ----- ._._ .._ - . DATE ............. -------- !% ..--••-...___- Alterations and/or recommendations: _-_-_--..__ --------------•----------------•--------"•-----...----------------------........------ • - - -- ............................ ------------------------------------ --------------------------------------------------------------------------------------------------------------------------------•----••-•--------•---- �r FINAL INSPECTION BY:-.__-- ----------------------- Date- -------- ._. _ 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