2334 - Laserfiche WebLink

Home Browse Search

t 1 f " APPLICATION FOR SANITATION PERMIT Pe + ©•" (Complete in Duplicate) J Date Issued Application is hereby made to the San Joaquin Local Health District for a permitto construct and instal)the work herein,described. This application is made in compliance with County O 'nance No. 549, JOB ADDRESS A D LO TIO i- 'l'_ - - ------ ---- -----------t=� -----„,R,�---- ._... ----- j ��f� t� Owner's Name--- - ---••- ----------------- ------------------------------------------------ - Phone '' Address-- Contractor's Name--_ ..--- .......... -• •••--•--• ....... --------- -------- ---- Phone ----------- Installation - - -- Installation will serve: Residence [ Apartment House ❑ Commercial [^frailer Court Q Motel ❑ ; Other- Number of living units: _ ___ umber of bedrooms ________ Number of baths _!_ ot size Q5 .. ___. ____ Water Supply: Public system Community system ❑ Private ❑ Depth,to Water Table ........ ft. Character of soil to a depth of 3_feet: Sand Graver❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Application Made: Yes ❑ No New Construction: Yes Noy.❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r n ___-__-_.M_Septic,/Tank: aDistance from nearest well_____ Distan ej fro jou dL_ ------------ _________ _____________ -------- No. of compartments.... - _. SizeLiquid de th.___W-,_ Ca 4 Dispos Field: Distance from nearest well Distance from foundation _ t----Distance;to near.`est to rn Number of lines____________ __�__ __ __�__y_L�ength of each line_____________ ft__Width of trench__fYp IQ►� p 9T e of filter matena�'+ e th of fil#er material_____._1_ _ Total len th--------( .. ............ Seepage Pit:, Distance to-nearest well---------------------- from foundation..............._...Distance.to nearest Jot line_____ ❑ Number of pits______________________Lining material______________________-Size: Diameter________---------- NiA . _-------------- Cesspool: _-_____Cesspool Distance from nearest well_________________Distance from foundation ._______________Uning material.—, `a ----------- 0 Size: Diameter------------------ _De th---------------------------------------------------Li id C.a aci Privy: Distance from nearest well_________ _____________________ ___________Distance from nearest building____:__- ___-_.__ ...r____:___: ❑ Distance to nearest lot line-------------•---- --- ---------- -- ...........--..............................--------------.........._...__ -------- Remodeling and/or repairing (describe)---------------------------------- ------ -----„_______--=-•- •------- -----..........•---• -----------------------............ - -- •-- ' ,� e- ------------------- --- - ------- -> .,� ---- I re bx certify that 1 have prepared this application and that the work will be done in aecordance:witA San Joaquin Ceu ordinances, We laws, and rules and regulations of the San Joaquin Local Health District. w ” e-o3- (Signed)..-•�r1-G� ---- -------- ----------- ------ ---------------- -- -------__ _ - -------------( r and/or Contrac :Title... --------- •------ ----- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse:side). �� rt FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED $Y .-',.--- ------------------------- _ DATE r REVIEWED BY ------- DATE_ •�' BUILDING PERMIT ISSUED= -- ---- QATE � Alterations and/or recommendations:_____-_ ` -- -- --- -- ------- --- -- ---- -- -- --- - _ _ '6- -1 �/� .------- --- f/---------C_ak--- i t E Z r leis 57 Z i4l, , .. , 4- L P TI l- -------- -----• - /� - ----- ---- Da#e SAN JOAQUIN LOCAL HEALTH DISTRICT IV c ? 130 South American Street 300,West Oak Street132 Sycamore Street 814 North "C”Stieet 0 Stockton, California Lodi, California Manteca, California Tracy, Celiffcrn'ia ES-9-2M 8-51 Revised W-2100