7935 - Laserfiche WebLink

Home Browse Search

, , APPLICATION FOR SANITATION PERMIT Permit No. _..�_ I � — IComplefe in.Duplicate], r ,T ? . , . , . Date ,Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h This application is made in compliance; with Count Ordinance No. 549. �+- • • herein described. JOB ADDRESS A D LOC ION..�?_ j' __ dol Owner's Name. ----------- ""••""►► ----- •--------- -- ----------- i : ---------- ress Phone---- --- --- .: ------------ - ontractor's Name---.-�___ ------------------------------•---- ---- -- _ ___ Insfaliation will serve: Residence Apartment House -"-'-+�- ------------- Number ---- --- Number of living units: _lf_-_- Number of bedrooms .-.Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Wafer Supply; Public system ,�,� Number of baths -_1___- Lot size ...: � e �( !�� L� -ommunity system :,,r ----•-------•-------- Character of soil to a depth of 3 feet: Sand ❑ Private ❑ Depth to Water Table . ...___ ft. Previous Application Made: Yes Gravel ❑ Sandy Loam ❑ Cla Loam ❑ No New Construction: Yes R No y ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if ublic sewer is available within 200 feet. Septic T k': Distance from nearest well_LVI�4R— pistan e f om oundati �` • a No. of compartments...._- a . ,tic F °n llafierial--C = + Size `TF"f` Li uid de t Disposal field: Distance from nearest well- . It�- q p --A/'�j '� Ca1. paciti4l, `Q.-_-Distance from foundation # _(, _ .-Distance to nearest lot line_, Number of lines------ � I ----- -- -�--------------Length of each line._ s"�' :- .�.. .:, ' Type or filter mat�ia� p Width otrench_._f�„7r��__,+�, -� r n � -- ------Total length---- w " -----_..-_.Depth of filter material-_L?,�- - -_� - � F- 5eepag it: Distance to nearest ell_ ' -�.-_-.__Distance from f�u dation__ Number of pits... __-.- -__.t_..Lining materiahh - E¢•-Dist�ce to nearest lot lime_ Cesspool: - --- ----Size: Diame'4er---___ P Distance from nearest wel ---------- -Distance fro foundation_..__-_- _-I_.- Lining.3 material--- ------------- - ❑ Size: Diameter............. ------------Depth--------- # --------------------- Priv ------- ----- --j---•-Liquid Capacity. Y Distance from nearest Weil_[.'___--_- -------------------------- gals. -------------------------------Distance from nearest building ❑ Distance to nearest lot line!-'~ -_--_--__-_ ---- - Remodeling and/or repairing (describe):____--,�--_- ------------------------------ ----- --------- ---------------------------------------- -- ------ ------------- = ---------------------'--------------------------------------------------------------------------------------------------------------- i hereby certify that i:have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed).----- I --- q County -• --------------------- -^ By: ::........ ...:. caner and/or Contract ----- {Plof plan, showing siz f lo`t;locati of system in relation Fo wells buildings, etc. {Title).._ /o Contractor) ------------ 9 an be placed on verse side). �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ ^ J' -------------------- y, DATE�•-e�- BUILDING PERMIT ISSUED. , f ---..._ti.' t iEWED BY / - ------- --------- DATE...-. Alterations and/or recommendations: ___--�,-1 . - DATE.._...-.— f _ ------------------- = 1 A -------------------- -- ----- ----- -.I_- `i ------ ------------------- - ��--- --------------- -= -- ---------------------------------------- •----- ' FINAL INSPECTION BY--------------------- 4. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak S+ree+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es-9-2M 745446 arwogo ,z-sa