11906 - Laserfiche WebLink

Home Browse Search

�e APPLICATION FOR SANITATION PERMIT Permit No. ..1..1.. � -- {� (Complete in Duplicate) Dote Issued 1 This Permit Expires 1 Year From Date Issued L)' Application is hereby made to the San Joaquin Local Heal+h 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-------. -;---- �/rte - _ 7~:j - mo i - ---------------------- --------------------------- Phone--------- ---------••-------------- Owner s ame------------- --- --�-- ----- ----------- Address-- ------------------ - `.[ .1 I - Phone.. d? Contractor's Name------ y A }tom ....... c"9- ------ - • ter El Installation will serve: Residence ]( Apartment House ❑ Comrnereial ❑ Trailer Cour} [] Motel tt Number of living units: -------- Number Number of bedrooms ...-- umber of baths :_/--: Lot size ----------7�-x ----------------• .r., 0 Water Supply: Public systemA 1 ;systern'❑' Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ 'Graveh1 kSandy Loam,❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ iNo Previous Application Made: Yes F1No4 New Construction: Yes El No FHA/VA: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ep}' T-k: Distance-from nearest well----------------- from foundation_-- _----.-----_.Material----.__--.--_-.----- -_-_------- nl y No. of compartments------------ -------------Size---------------------------------Liquid depth Capacity 1 ii� istance from foundation---,4Q- -.Distance to nearest lot line--�------.---- Dispo I �d: Distance from nearest well-�Q/➢/�-D• ,� /i y Length of each line-_-- -3--Width of trench---_�w--l----- -- \ Number of lines-._-__-_----�-. ---- 9 ---- / _ Total len th__s -- ----- ---- I Type of filter material_--._�-�1t---Depth of filter material----r�-_-------- 9 r� Disfan;g to nearest lot line�s5---.------ Q See a e Pit d Distance to nearest well__.--/ VA4--Distance from fndationf2---------.--. Depth- - sS- -.-- (� Number of pits.._--I__---- ----Lining material tel-------Size. Diameter-_.. .- Cesspool: Distance from nearest well_-----_-_--_---_Distance from foundation--------------------Lining material-.-__----------_-_--_----_---------- Depth----------------------- ----------Liquid Capacity--------------------- --gals. ❑ Size: Diameter-------------------------------------- ---- --------- 6 Privy: Distance from nearest well ------------------------------------------------Distance from nearest building-___-----------_-------__----_-.---_---- ❑ Distance to nearest 4ot line-----------------------------------------------------------------------' ------------------------------------ 4 ----- ------------------------ ~ or repairing (deiribe}:_ � ��Remodeling andL- _ - - --- ----- - ----------- -- --- ------- ----- --------- ------ - -- ---- ---- -------- ,®> ----------------------------------------------------------------------------- ----------------------- - - application and that the work wick be done in accordance with San Joaquin County 1 hereby certify that I have prepare ordinances, State laws, and rules and egula ns of jhe San Joaquin Local Health District. (Owner and/or Contractor) (Signed) - . ------ (Title) i (plot plan, showing size of lot, location of s ste in elation to wells, buil i s, etc., can be laced on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE------- ---- --------------------- APPLICATION - 3 REVIEWED BY-------------------------------- --------------- --- - - - DATE - ------------------ BU I LDI NG PERMIT ISSUED--------------------------- - --------------------------- - --------- --------- DATE-- -- ------ --- ------ ----------------------------------- Alterations and/or recommendations:------------------------------ ----------- ---- ---------------------------- - ------------ ------- ------.•------------- ------------•---------- -----•-------------------------- -------------------- ------------------ ------------------- ----- ----- ------------------------------Y- ----- --- ----- --- L4 C f FINAL INSPECTION BY---------- - --- Date---- --- `-- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Y 130 South American Strea+ TracCalifornia Stockton, California Lodi, California Manteca, California Y ES-9-2M Revised 8-'59 F.P.Co.