8359 - Laserfiche WebLink

Home Browse Search

-q APPLICATION FOR SANITATION PERMIT Permit3..y_._1 _ /'" ,. •; {" 11 Q (Complete in Duplicate)� 6 Date Isr2led ...... Application 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 Count Ord' ce No. 549. JOB ADDRESS AND ATION______ Q_N _____ �4_- ------------------------- - Owner's Name - Phon - ---------------------------- Addres --__-_ Contractor's Name---- _ ._ ............. ...._l___.r------` ->---------------------------------------------- Phone--� __ r��7`_ Installation will serve: 'Residence 9/ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/. Number of bedrooms _ `__.'Number of baths ../ Lot size ____________________________________________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ C y Lo ❑ Chay ❑ Adobe �❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: l eseplic k�o ermitted if public sewer is available within 200 feet.) Se.�No tance fro _Distance from found4tion_/_O.. --..Material----- k---------elo. of com artments_.__ _.________________Size_...- -r_J-p 1---- _Liquid depthQ--`�.--.----.CapacitY.!'�, E° '� osal Id;- Distance from nearest well_/ _.Distance.from foundation---�Q_.ii_ istance to nearest lot line--- Number of lines------/_________________ _____Length of each line Q.__'t c , -----Width of trench___--�-SC``_...--_____-- ..�(,� Type of filter materia e__-Depth of filter material_,fr!<__'-_`►_"_`__'__'11otal length--,99- _____________________________ Seepage Pit: Distance to nearest well______________________Distance from foundation-------------------.Distance to nearest lot line.-____._.___-_--_ ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Dept h__.__-.---.___.._-_____--_--_---- Cesspool: Distance from nearest well----------_------Distance from foundation--------------------Lining material______--______-_-__-.---_-_-__---_-_-. p ❑ Size: Diameter-------------------------------------Depth------------------------------ ---------------_---Liquid Capacity----------------------------gals. (v Privy: Distance from nearest well-------_--------------------------------------___Distance from nearest building.._____-_-._____.__-_-_______._.__-_.__._. ❑ 'Distance to nearest lot line---------- ---------- -------- - --- -------------•-•--------------------------------------------------------------------------- Remodeling and/or repairing (describe):__C7 '?l . -S %y --- --------- -- ------- --- - ------------- -------------------------- -------- --------------------------•------...--------•------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------ ------------ ----- --------- -- ----------------- ---------------- ------------------------------------------------------------------------------- ------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin L I Health District. DAY&NIGHT [Signed)-_- Sepr- qnk-5ervies--------------------------_-_----- or Contractor g 1206 So.Eldorado HO 2-7046 r ) Plot Ian, showing size of lot,. location on�of s�lstem in relation to we-_,.`^----- -- ----- ---(Title ______ __ _ __________ ------------------ a ___ B ( p g y l , buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ r ------ ------ DATE-_.---J'-•----- -•-------•---------••------------ REVIEWED BY ------ --------- ��~ - DATE BUILDING PERMIT ISSUED---------------------- DATE Alterations and/or recommendations: ------- �4` = - ��` �� ° ei -------------- ---------2 - A------ - - --- --------------------- - -------------------------- -------------------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:... -^ __. /1.d.�--------------------------------- Date. '� `"Z `� " ------------- ----------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOD