5595 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit N `—�____ .... I (Complete in Duplicate) Date Issue' 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 with County Ordinan e No. 5 JOB ADDRESS AND,LOCATION... cr7 P'Gcl ----- G Owner's Name--------------------------------------t.j_ J;�..... --------- - ----------------------------------------- Phone..- Address �0"l ---------------------------•-------------------------------- ---------------------- { --------------------------------------- / Contractor's Name---------------------------- - .y1'_1'1_s/7-----------��_��--4T=--------------- ------ Ph Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [3 Motel [_] Other [_1Number of living units: __l-__ Number of bedrooms __-�9lumber of baths ___/-- Lot size _- -= / - ------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table eft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No// —New Construction: Yes E3 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No(No septic tank or cesspool permifte if public sewer is available within 200 feet.) _ . Material_-------------------------- ------- --- Septic, ank: Distance'from nearesttll. _______Distance from founddtion___ No: of compartments.---- --- ---- rry`---- - --- --Sae _-:; �(��r--�-------Liquid depth--- .-----------Capacity--��-C1-'� Dispos Field: Distance from nearest well_ �1_ _Distance from ton -_--_-Distance to nearestline_O�_..__+_ r Number of lines____ !/- � j Length of each line-- D_'_-_.--.----.Width of trench of filter material.F-/';,:__ Depth of filter material----./ 'I ___Total length___-_c"__ ____________ Seepa ePit: Distance to nearest well _ __0--.___.___Distant A-1 -1/t fndation_____ d?_.__.Distance to nearest lot _____Linin materiac � ---.Size: Diameter------� f�--_Deptn__e�-47---------------- Number of pits.-_ .___.._-_ g Cesspool: Distance from nearest well----------------- from foundation_____---_______._-.Lining material_-.----------------.____________-__-. ❑ Size: Diameter------- -----------------------------Depth-------------------------•-•-------------------------Liquid Capacity----------------------------gals. Privy: Distance(from nearest well------------------------------------------------Distance'from nearest-building______._____.-__---..._..____._________. ❑ Distance to nearest lot line------------------------------------------------•---------------------•--••--------------------- Remodeling and/or re airing (de ribe�: =� ` --------- -------•`� c...../40- ----- --------------------------- ' 1-0 ------x...Lc%�- --- - '` `�^ a"�----•------- - ---------------------------------------------- -------•----------•------------------------••--•-•---------- ----------------------------•-•---------------------------- ----------- •-------------------------------- ------•-------•--------------------------------------------------------------------------•--•------------- -----------------------------------------------•------•---------•-----------•------------------------- I herebyra hat I hay prepare. this application and that the work will be done in accordance with San Joaquin County ordinances, St , an rules and re lations of the San Joaquin Local. Health District. (Signed)--------••-----------------•-••------------------ ------------- - ----- ------ ----- - --------------------- ----------------- — --- - ��3' ontrac tor) By:--•-----•--•----•-••-------------------------------•--------.-/- ------------- ----- (Title)---- (Plot plan, showing size of lot, location of syst m in relation to Ils, buildings, etc., can be plg ed on reverse side). L FOR DEPARTMENT USE ONLY DAT ''" APPLICATIONACCEPTED BY-- --------�--------------- ---------=•-------• ------------------------._-...-------- �-- --------- ----------------------------------------- i- BY - - ---- DATE ------- BUILDING PERMIT ISSUED---------- -- DATE .. _-k_______-_ _._ .,__._._____.�__________ ___________________________ Alterations and/or recommendations:-:--- �( ...........•----•----_----------------------------------- -------- F 4 I6-1---- ----- . ... - --------------------------------- ---_--------------------- -. - . ,. U-------- ----------�----- -------------------------- 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