2343 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit N`o. Z!------ -- -- I y y (Complete in Duplicate) Date Issued 4 z_7vL Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AN LOCATION__.__ _ - ___/ Owner's Name------- -�-�------ 1S "t - ------------------------ Phone---,+Q1H�`------------ Address------------- --. Dt�rx_ � 00 - � �- �--- --�-------- Phone-- --'. Contractor's Name__.1r 1 _ _�•_ Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ __�j�-��--'�'-�-�Q-Q - Number of living units: -0---_ Number of bedrooms _Number of baths _1-- Lot size �• --------------------- Water Supply: Public system IK Community system fl Private ❑ Depth to Water Table -------- ft. I Gravel Sand Loam Clay Loam❑ Clay ❑ Adobe K Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y ❑ y F Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ /1+�e►� TYPE OF INSTALLATION AND SPECIFICATIONS: i4 r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1"' ptij T �k: Distance from nearest well-----------------Distance from foundation___-__-_____--.___.Material__--____-_____-___-_-__________________________ No. of compartments S'sze ---------------------------Liquid depth-------------------4----Capacity - ------ NN -/Q_--.___- Distance to nearest lot l��_- --------- _ Disposal Fiel Distance from nearest well_!_LQI4�►__Distance from foundation__- ___ Number of lines----I-=------ -----------------Length of each line_ A-0-21--------- Width of trench---�F '�---------------------- 66-1 Of Type of filter material_I�__RAi------Depth of filter material__-_�-- �---.--Total length___- 0-�F--• i. Seepage Pit: Distance to nearest/well_-40s ,-__Distant fro foundation----��.�.--.Distance to nearest lot line__-. c Linin material_ _Size: Diameter---.. ��--- -Depth_o �.lr- ------------------ Distance from nearest well________________ Distance from f Number of pits______ ___________ g ` Cesspool: _ oundation------------------.Lining material__-__-____-------------------•-----•- ❑ ---------- ----------Depth------------ ------ - ------------------------_Liquid Capacity--------------------------- Size: Diameter--------------- 9 ,� w Privy: Distance from nearest we4l-------------------------------------------------Distance from nearest building------------------------------------------ I ••--------------------- Distance to nearest lot line-_____-________________ -------------------------------- Remodeling and/or repairing (describe)---------------------------------------------------- --------------------------------------•------------------•-------•----------•--------------------- # --- -- =- - -- •------• - --------- • - ----- - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andAr les and' regulations of the San Joaquin Local Health District. (Signed)------ 2J�7--�-i + ----- -0./a�C�._�t2.C.'i----�------------------------------------------------------- --------- --------- ----_-----(0�� Contractor) � - ------------ -- --- ------------- - ----- ----------------------(Title)--- -1lYIF �-L71- ------------------ of system in relation to wells, buildings, etc., can be placed on reverse side). s (Plat plan, sho 'ng size of lot, locati . FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- ------------------------------ ---------- ------ -- ------------------------------------ DATES ------------------------------------------------ REVIEWED BY DATE ------ .s�----- ----------------------------------------- ------------------------- BUILDING PERMIT ISSUED — DATE--------- �+;;� Y _____________ -- -- _-______--_ _______ Alterations and/or recommendations:-----------------�:.__-- -- _ %4 � Date...... ��J_��.------------------------------------------------------------------------------------------------------------------------ --------------------------- FINAL INSPECTION BY----- --------------1----� -�----- - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y ES-9-2M 8.51 Revised W-2100