7972 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit� 7 � (Complete in Duplicate) A Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w rk herei described. This application is made in compliance with County Ordinance N . 549. JOB ADDRESS A LOCATaIO --- �I -------------- Owner s Name--- Phone �► -------------- f -------•--• -- ------------------ ------------ Contractor's Name--------� '_..i--. '_ C -----• i__t._ -------rr-=------------------ Phone ---------�zD _- Installation will serve: Residence 0 Apartment House ❑ Commercial El Trailer Court Motel ❑ Other ❑ Number of living units::l1---__._ N or of bedrooms -------- Number of baths -------- Lot size Water Supply: Public system Community system ❑ Private p Depth to Water`Table -------- ft. Character of soil to a depth of 3 feet: ,Sand ❑ , Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: is [RI<o ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well._- ° P �+ - .__Distance f�om f udation M ial -------------------------` No. of co I�partments-._c ------------ --Size.�' _o<l_�--.1C-_Liquid depth____ Capacity__ ' . r a �, Disposal Field: Distance from neares .well-- P?_._._._Qistance from folunc _tion__--p1-st. ._--Qistance to nearest lot Number of lines_____----- ---- ----- Length of each line---V_Q--.`---------- -----Width of trench--------�-_ ------------------ .-Depth - - ---__.--- --- Type of filter materia �.._._Depth of filter material_-_.�. -- Total length__-_:_ - f Seepage •rt: Distance to nearest well--/.400 �' rr �` -__--____Distant , from foundation__--,� D�stance to nearest lot line---- r [Y Number of pits._. __._.---__Lining material_. _ �G� ------ Size: Diameter.___� p ' 4_. r _ Cesspool: Distance fik m nearest well_----------------Distance from foundation- ------------- Lining material------------------------------------- [] S;ze: Diameter-- -------------- ----- --------Depth----------------_--..---------------- -----------..Liquid Capacity. -•-----•-----------------gals. —Privy: Distance from _ _ _ nearest well---- from nearest building ❑ Distance to. nearest lot line___ - - - ----- - - Remodeling,•and/.or repairing.(d escri ._.__.._ �^-- -_•__-- ._ � l3 ` - ----• ----- ________________-----------------------------------------------_ ______ __-_.____---__________-.------------------------------------------------ - - _______________ _ _ __________ ____`_.___-.__________________-_-._�..._______________.__________---________.._ _--_____._ ------------------ --- -------• ------------------------•--------------------•--•--------------•-----------•------------------•--•----------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. (Signed)-__ DAY& NIGER k-•'rtmk-3erwice----------- ----------- ----- -----,------ - ----------------------------------- --(Qwn•-and/. Contractor) ,+I By:.• -_---1206 So Eldorado-•_HO2-7aeA Iii {Title)------ - - --------------- ----------------- (Plot pian, showing size of lots &P915tem in relation o wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ y DATE_ -- - ---------- --- --------------- ---------------------- -------------------------------- DATE------------ BU I LIQ NG PERMIT ISSUED------'---------------------- -- - --- - DATE ----- ----------------------- ------------""" Alterations and/or recommendations:_--------- - ------ ---••--------•----------•--------•---- ---• --------------------- - - -I - -- t--rte.----- ----- -- --------------------- --- -•-----•-------- -� - = 4e--- -----�------��--: �------------------..-------------- ---------------•- - -• ------- -- ----- M------------------ - - -------------- --------------- - -------------------------------------- -------------------- ------------------------ ----------------------------------- I r FINAL INSPECTION BY:------'' -------------------------------- .Date j = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreat 300 West Oak Street 132 Sycamore Street 814 No- Stockton, California Lodi, California Manteca, California Tre E5--9-2M 145446 AT W p0❑ 12-54