9888 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT PermitNo. Yy (/ Application! l Complete in Duplicate) bate issued 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 rdinance No. 549. JOB ADDRESS AND L CATI N-j--- J ---------- ------------------------ ' - -------------------- caner s Name------- ----------- -------------•---•--•--- ----- -------------- ------ Phone---- rens - -------------------- ----------------------------------- --- Contractor's Name___________ - ,�,� -------------- ------- ------- ------- •----------•---------------------- Phone_.__.---•---•--•----•-------- ----- Installation will serve: Residence 2 Apartment House ❑ Commercial E units: _ g El Trailer Court E] Motel E] Other Number of living ❑ /--- Number of bedrooms _4— Number of baths -_ Lot size f Water SuPPIY' Public system 93-<ommuni}Y system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ervardpan ❑ Previous Application Made: Yes ❑ No Pq" Now Construction:, YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ �rFidA/VA: Yes ❑ No �. (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se�ati Tank: Distance from nearest well-_._____-______ .Distance from foundation------------------ Material-----------------_------------- No. of compartments--------------------.... 1 iquid depth Capacity -------------- ----------------------- �Dispo I field: Distance from nearest weal-_____--_--__---.Distance from foundation------.-------------Distance to nearest lot line------..______-- 1 Number of fines________________ -------------Length of each line----------------------------- Width of trench-------------- Type'of filter material______________________ __Depth of filter material------------------------, Total length. ------------------- - - ------------- Seepage it: Distance to nearest well_•--Distance f m f ndation__ _ pp -a ___.Dis�t�a�nce to nearest lot line__ ©-- Number of pits_- /--_----_--_Lining material__ - -- i- -- Size: Diameter-,?.?_ --------------- Distance � Cess oof: Depth----'�'`'- ------- - ❑P from nearest well-----------------Distance from foundation--------------------Lining material--_-_--__.____-_____--__--_ Size: Diameter---------------------------------------Dept h------ - -- ------- = Liquid Capacity --------gals. Privy: Distance from nearest well ❑ ----_Distance fnearest building--------------___� Distance to nearest lot line________-_____ fro_ ------.----.--___. - ---------- Remodeling and/or repairing (describe)_____________ ___ - 1-11 ---- - I -••---•---•------- --------------------------- --------------------•---------- ------- -------------------------••-----------•------------------•----------------------------'-------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County , ordinances, State laws, and rules nd>regula}ionSAOf the San Joaquin Local Health District, 1 (Signed)------------------- -- -- ------ ------------------- _ ) - - Contractor) (Plot plan, showing size of lot. location BY�------•--------•----------------------------•---------------- 1 � (True)of sy in.relation to wells buildin s, etc., cart be 9 placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY i ---------------------------------------------------------------------------------- DATE-E: REVIEWED BY-- - ,ti - 9 BUILDING PERMIT ISSUED---------- _--_- CM - ---- DATE-- ---------------------------------------------- Alterations and/or recommendations:----' ----------------- -------------------------------------- DATE------ E�--------------------_ ----------------------------- ------ ---� -C_-,3'------- --�•>,-•{�- - --- -------- ------ ------ ---- ---- -------•-- _ - -------- •------------- ----- ---•----•-- ---�-gra---� ----- -- ,.�. ---- ---------- --------------------------- ---------- 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-4-2M , Revised 1-57 F.P.CO.