3629 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _1:0 ?---4__? (Complete in Duplicate) Date Issued 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION----------- -- ------ ®� L, Owner's Name - --------- --------------------- -------------- Phone.--Q_fc _ Address - �11__7 2CIj flJ" �- -------------------------------------------------------------••------------------ Contractor's Name -Lihl-ac�_ �-.' Phone Q --------- -------•----------- ? F Installation will serve: Residence Apartment House ❑_�mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of,bedrooms _ 7___ Number of baths L--- Lot size ----1_`_42----._ --- --C?__[ -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Ix/_at, I F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application-Made: Yes ❑ No b( New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t S is Tank: , Distance from nearest well__ _____ _Distance from•foundation--------------------Material-____-_________....__________________________-_. 13 � :1 r��--�7 No. of compartmentsSize------------------------------`Liquid depth--.---------------------j Capacity----------------------- `N Dis al F' (d Distance from nearest well--------------_Mstancelfrom foundation--------------t..---Distance to nearest lot line----------------- Number of lines------ ---- ---------------------(Length of each line-----------.--' -`-----Width of trench-."' ;---------------------------- Type of filter material-_------------ --------IDe th of filter.material_____--.____ _-------Total length_._______ _._____________ Seep? a Pit: Distance to neare t well__,�#x�a---=Distance fr m foundation-1�_�_-__..__. st nce to nearest lot line_. Number of its___. ._'__- ________,Linin material �/ P .). { g L�:f�ic -____Size; Diameter- X1 De tn_. y, P {{. . Cesspool: Distance from nearest'.well-______________ Distance from foundation--------------------Lining material____-___!--------------------- _ ❑ Size: Diameter' F ------------ ---------!Depth-------------- ------I----- `--------------------Liquid Capacity---------------------------gals. I Privy: Distance from nearest,well-------"_':___________________________________Distance from nearest building _______________-.-___.._ ❑ Distance to nearest lot line------------- • " - — 11 -- --- ---- • ------------•-•-----•--- = ------------•------------ -------- ------------------- Remodeling and/or repairing (describe):--------------------------------------------- _ f -•---------------------------- ---•--•----------------------------------------•-------------------------------------------------------------- ----------------------------------- -------- - -------------------------•-------------------------------- -------------------------------------------- --- .. I hereby tify that I have prepared this application and that the work will beAone in accordance with San Joaquin County ordinances, S laws, andIrsnd regulations of the San Joaquin Local Health District.(Signed) _c— -------------P { , Contractor] By:.------ ----------------- -------- ----------------- - -- --(Plot plan, showing size of lot, location of systerelation to wells, uildings, etc., can be pla ed on reverse side). �. j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ''f�----------- ----------------------------- DATE--------- •.. - ------ -------- -------------------- REVIEWED BY ---------------------- DATE t ------------------ BUILDING PERMIT ISSUED---•---•---------------------------------------------------------------------------------------------- DATE. ------------------------ Alterations and/or recommendations----------------------------_- -------------------- -----------•----------•---------------------------------------------------------------------------------------------------------------------------------------------.----- --------- ------------•----------------------•---------------------------•----------------------------------------------------------- ---------------------------------•----- ------------ -•------•------------ ------------------ -----------------------•---.------ ------------------------------------------------------------------------------------------------------------------------------------------------------- F1NAL INSPECTION BY:_ - Date--- ------------------------------------------- SAN -- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi. California Manteca, California Tracy, California ES-9-2M io-52 Revised W-2140