5771 - Laserfiche WebLink

Home Browse Search

' APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No.� 7-7..l------ Date 7 /Date Issued Applica+ion 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 Ordinance No. 549. JOB ADDRESS AND LOCATION •�+7_'/3,6 --------•-•------------------------ ------- JOB Owner's Name-------------- �------- ---- , 4 -------*-------i•..... --------- 4 �---------- Phone ------------------------- ---------- Address------.-! _ ._ ---------------' --------------•--------------------------------------------------------------------------•--------•-----••-------------•"------ �r�jj i Contractor's Name ....... /".-- _ _ _ __ �''" -- i `5r'�"�"`"�""-" �'---� �--------•---,T.�-�.�---------•-------------------=-•--------------------------- Phone. _ .- --- Installation will serve: Residence Apartment' Hoose ❑;. Commercial ❑ Trailer Cour} ❑ Motel ❑ Other ❑ Number of living units: _I___ Number of bedrooms -__e2_ Number of baths I--- Lot size ____ t�---- ------------------------ Water Supply: Public system P? Community system ❑ �Ptr,vate.❑_Depfh_to Water, Table -�/ ft. 4 + Character of soil to a depth of 3 feet: Sand ❑—G aIvel E]Sandy Loam El ay Loam El Clay ❑ Adobe 8 -'Hardpan 11 Previous Application Made: Yes ❑ No[tj�New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: -- _••� "'`-`� ""'" "'" (No septic tank or cesspool.,permitted if public sewer is available within. -200 feet.) Septic Tank: Distance from nearesr well------- -- Distance from foundation--'-^"-__..-_.Material_________________________________________________ �p ___Liquid depth Capacity p' ` e � t • i s,os Field: Distance from rnear st 'Well___._, ._,._D_stance from. oundatlon___________ _______Distance to nearest lot line _____--..-_-_____ Number of lines -------- t___________•-- --_f--Length of eac line --------------`-------"------Width of french -----------------------------____-- Type of filter material* _-,__._,--- - __Depth of filter material ---------- -1 ------- Total length ---------------------------- ____________- �e e Pit: Distance to nearest well___________________ _Distance from- fo ndatlon__a,e .e ------.Distance t-- nearest lot line -_06 _______ 9� Number of pits.__._�__�_________--Lining,materiaL'S__'�-1.Size: Diameter__ ......... .... Depth_._a ~--________.__________ Cesspool: Distance from nearest well-________________Distancetifro m unda#ion------------ #------- Lining material---------- --------------------------- ❑ Size: Diameter ---------------Depth__, ?= --1 ""-------------------- Liquid Capacity gals. Privy: Distance from nearest well ------ ------------------------------------------- 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 County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. I- R (Signed) �`� - ------- -----------------------------------------------r_ "„------------------------- (O ,ner and/or Contractor) By:._ �` `''�"L�'Q I,eY,..�r•�`----------------------- (Ttlejl (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- --------------- -------------------- DATE----------------- REVIEWEDBY --------------------------------------------- --------- t'° -----------------------------------------------. DATE --------------- --- r._ BUILDINGPERMIT ISSUED ---------------------------------- -------------------------------------------------- ----------- DATE .---------------------- ------------------------------------ Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------------•--------_---•----------------------------- -------------------------------------------------------------------------------------------------------------------- ------------------------------- ------------------------------------------- -------- - - - ------------------ FINAL INSPECTION BY:- - ------------ Date_ - . - ----------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California Manteca, California �e 0 IkA • ge..:•e.F W_91nn 814 North "C” Street Tracy, California