9091 - Laserfiche WebLink

Home Browse Search

51 APPLICATION FOR SANITATION PERMIT - Permit Na. J.71_ ._ (Complete in Duplicate) 5 i I � Date issued __� ! Application 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. JOB ADDRESS AND LO TION______ f - --------------------•------- I Owner's Name--------- ------- - ----- ------ ------------------------------------------------------------------------------ Phone---------------------- -.---- Address --- ----- �-------------------- ------- -------- -------------------= ::� = Contractor's Name-____:M - --� '- � Phone--------------------- Installation will-serve: R Apartment House ❑ Commercial E] Trailer�fCourt El- Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths4$7_'L.ot size ------ Water Supply: Public system ❑ Community system ❑ Private E-4-15epth to Water Tab4e Ya__ ft. Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E� o ❑ FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available wi+hin 200 feet.) I Septic Tank: Distance from nearest well/0".47-Distance from foundation_A�___.___-.Material --&-e_ d-__- ---- koa No. of compartments_ Size_ / � 0 -AA* depth--- Capacity____ J _____ ______ .__ Disposal Field: Distance from near 1sst welllee.- Distance from found aryfion__ Q..___--Distance to nearest I f line----------------- ----------------- Number _-t3-_-'--___ Number of Iines�TLength of each line_!- -- _ Width of trench_..__ -- ff - _ ---------------•- . !. Type of filter material,�.r __ Depth of filter material___I,�___-,__°Total length..-_.,�j -ZI-Q..._______ y -----•----•- Seepage Pit: Distance to nearest, ell___ �--____ istance fro fou ation_ ::___D'st ��e to nearest lot li eJ_______________ Number of pits---- _--- ---------- Lini material/g) _ . $ize: Diameter-- ----------Depth----i i ------------------- Cesspool: Distance from nearest wtil ________________Distance from foundation--------------.-----Lining material___.____.__.__.__________-__-__---__. ❑ Size: Diameter-------- -------------Depth----- -- - ----------Liq id ap city- - ------------------gals. l Privy: Distance from neares " _[-8-�"-1-------------------- --Distance from nearest bui ding___.stc _____ #" ❑ Distance to nearest lot line--------------------- - f` Remo ling and/or repairing (describe):- _-- � -- --- �--•- ��-"-'-- --;;;;WV_-- •• •- ----• ---------------- ---- -------- ------ -------- -------- ------ e ------------------------------------------- - •-------------------------------------------------------- ----------•---- -- -------------------•-•------------------------------- I hereby certify that I have prepared this application and that the work will be one,in accordance witk' San Joaquin Coun ordinances, State laws, and rules and regutions of the San Joaquin Local Health District. Y � (Signed)--. -----I- •-- - ---- {Ow ------------- ner and/or Contractor] �y By:---------------------------------------- y-------------------- `------------------------------------------` ` ------{Title)------ �l�f. ------- (Plot plan, showing size of lot, location of system in relation-to wells, buildings, etc., can be place n revers de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----- ----- -`------------------- --------------------------------------•----- DATE...----•-------------- ' r� ------------------ ---------- REVIEWED BY_---------------------------- DATE_ �` ! - BUILDING PERMIT ISSUED------------------ -------- - DATE €3f iv Alterationsand/or recommendations---------=---•------------------------------------------------------------------------------------------------- ------------------------r --=.._ d-'y-------A,n,5------- f----- -s L l ocK------rc.�___--- rT-----'---g--•---rs------.. +_ T_.Z)e.2�-7,10--------- i s-5� ------ rs'4 �H- • ^ri.14. �� 'eke,e' '�' '' .P��Y.....7't�.... ----- Wit----------------- , __ ✓ .... Fi ----••------------------------ !�= -----��°�-----�'�" ��_�-------------Fia �°------- �1_"�_P�`�T-------� �4 ��--------------= ---------------------------- FINAL INSPECTION BY:."_ i Date-------------------- ` r ``'� -----------------=---------- -:. , I 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 i ES-9-2M Revised 1,57 F.P,CO.