4046 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT `" Permit No. 1�-- ' (Complete in Duplicate) Date Issued Vy/ I Ali a ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in complianceWwith County Ordinance No. 549. 30 !� ..acs --�- --------------•--------------------- ----------------- ------------ JOB ADDRESS AND LOCATION---------- -- - ---- �j P - - N.- --A--�------------------------- -- ----- ------------------------------- Phone-------------•-------•----•-------- A- --•--- Owner s Name-------------o`1=.�-------------- F3.s��-.�_-..__� - 1 Address.-----------•---------•------------------------• - i�------- --,_/ k ��--------------------------------------------------------•---- Contractor`s Name.......------------------------------------------------1✓/ r-- Pho Phone -------------------------------- Installation will serve: Residence ❑ Apartment House ❑ CommercialTrailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ___________t ------------------- Water Supply: Public system Ercommunify system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [ISandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El Hardpan ❑ Previous Application Made: Yes ❑ No-F] New Construction: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)t ` ' "-.M�t tial_ � _ �----------- Septic ----• Septic Tank_: Distance from nearest well ----__Distance from foun_dation_-._!--____.____ ------------------------ ----- No. of compartments_________ Size X t Liquid depth------� -------Capacity---� ------ I Disposal Field: Distance from nearest w II_____--�---Distance from foundation____.�Z)........Distance to nearest lot line----- ��____. Number of lines____.___="__ ---- -- Length of each line--________ Width of trench..______ o --f---- Type or filter material__- _- Depth of filter material___-_-------_� Total length________________________________ Seepage Pit: Distance to nearest well______________________Distance from foundation__:"_.____..___..Distance to nearest lot line------_.______.__ ❑ _ Depth---------- --------------------- In Number of its--- ------ ---------- Linin material-�-- ----- ------ ----�e�`•Diameter--------------/- - - p g r `\-------Lir g material------------------------------- ---- Cesspool: Distance from nearest well______________ Distance from fours°dation__': tlgwd Capacity------------------------.___ els.. _ ❑ Size: Diameter------------------------ = ----------Depthg Distance from nearest well-------------------------------I ------ Distance fro . nearest building-------.---------------------------- "---- Privy: J Distance to nearest lot Ime-------- ----------- -------------- ------ ------------- ------------------------- Remodeling -------- -Remodeling and/or repairing (describe):--------------------------- -------------- ------- �✓ - ----------------------------------- -.. ------. - ---------------------------------------------------------- - = __ - 1 hereby certify that i have prepared this applicati n and t at the work will be d no a in accordance with San Joaquin ou ordinances. State laws, and rules and regulations of the`San Joaquin Local Health District. -------------------------------------(Owner and/or Contractor) ,---------------------(Title)------------------ ------------------------- ----------------- log BY IXV(Plot plan, showing size of lot, location of system in rela+ionV..... ells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ---------------------------------. HATE--------------- c -------- REVIEWEQBY s DATE--------- -•------------------ 1.---.-3----------•------------ BUILDING PERMIT ISSUED--------- ---------------------------------------------- ------------------ IF��'r'— - DATE------------------------------------------------------------- il Alterations n or r mendations:__--___ _ �� ,/Y,d - I� 'r' ------ `'' r--- , : ;R------- -- ------------------- -------- FINAL INSPECTION BY---------- --------------------- -------------------- -------------- Date- --------------------------- --- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y rS—.4=2M 10-52 Revised W-2100 -