9390 - Laserfiche WebLink

Home Browse Search

1 APPLICATION FOR SANITATION PERMIT Permit No. ... .- .d. I Com lets in Duplicate) r p p ) Date Issued `Yz Application is hereby made to the San Joaquin Local Health Di t 'ct for a permit to construct and install the work herein described. This applicafion is made ' compliance with Cou ty Ordinanc o. 549. 1 ` I t JOB ADDRESS AN C TION �_�, -; � ---444,- Owner's ------ -Owner's Name----- = -- -------- -- --- -------- - ---- R Phone_ _ --------------------------------------------- Address-----1---------------- ;M2 f••ami.I .. G4 €. -------- T -------------------------------- ----------•-----.+.._...--••------- Contractor s Name-----Ph"-_� `'' ---- -----------• ----------------------------•----•-•--•-•------------------------ .Phone--- l.- Installation will serve: Residence [Ijf partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. -/-- ____ Number of bedrooms Number __ of baths __ __ Lot size _____ { ______ Water Supply: Public system �aommun'ity system ❑ Private ❑, Depth to Water Table ft: Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe eLdpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes p No ❑ FHA%VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) j_fic Ta �� Distance from nearest well----------------- from foundation----------------._ Material-----_______.__________________-__-_____._.____. -' No. of compartments------------ ------------ Size--------------------- .---._._Liquid depth--------------- ------- Capacity---•-------------- ---- 4 or Distancefrom nearest well- - . .Distance from foundation __ Distance to nearest lot line___. - Number of lines_____:__ F Length of each line , __ _____________Width of trench�_Z�/----------------- Type of filter material- _ e hof filter mate ria L_. i °AA�__.__Total length._._ r$__�_____ Seeplage K : Distance to nears ell �_�-_.__D' ante from foundation��----_..Distance to nearest lot I e -------------- Number ___ _ ,_ Number of its___ __________ material_ Size:'Diameter___ ":------Dep...--- .- --__-_-_ Cesspool: Distance from nearest well-__--__________Distance from foundation'__________________Lining material-------------------------------------- ❑ Size: Diameter = Depth-----------------` Liquid Capaci#y------------------------- gals. Privy: Distance from nearest well-. ---------------_-----__----_-__Distance from nearest building__________________.____..-__._______-__ _. # Distance-to nearest lot,line- =:-=-=-'---=----------------------------------- ---------------.._--•--I--------------------------------------------- 00N --------------------------------- - -- ------ Remng and/or'repairing (describe}: = ? 1--� _ � r -----:t----- --------------- , -- - -- - ---- ---- - ---- ---- r-- ---- ------------- - ----- - ----- ------- -- - -- - .. ------•----•--------------- ------•----•----------------•---------------- ----------- --------•--------------------------,------- I'hereby ce ify that l have prepared this eppl' anon ane the work will -be done in accordance with San Joaquin County ordinances, S to laws, and rules and egulations the San Jo quin Local Health District. (Signed)---------- `: ------ - --------------------- --- ----------------=------------- -- --------- ontractor) By------------------ ------(,Title)- ------- - 11 -------------------------- ; (Plot plan, showing size of lot, location`of system in relation-to ells, buildings, etc. can be pi a on reverse side). 1 �11 FOR DEPARTMENT U E ONLY N� § APPLICATION ACCEPTED BY-------------------------- ----- ----- t� =- -------- ----------------- DATE----------- I REVIEWED BY------------------------------------------ - ------- . . - --------------• DATE---------- iO ------------•---•- y BUILDING PERMIT ISSUED---------------------------------- \.------------------------- -----•--- DATE---------- -j-------------------------------------- Alterations and/or recommendations:--------------------- --------------- ---------------------------------------------------------------- ---------------•---...__._.. -------------------• _ -- - ---------------------------•-------------------•-- --------------------- 1r� ��--� � � -----------1A_ _ ------------- --------# - -------------- ------ 7------ ..------------------- ---------------------------------------- ------------------ ----------- -------------------------- --,AT---f---------C ------------ ------------ --- -------------------------------------------------------- ------------------------- ----- 7 FINAL INSPECTION BY:. `" A�+ "•------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street ' Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 EP.CO.