14578 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ------------------------------------------------ ..................... --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... --------------------------------------------------------- (Complete in Duplicate) / . This Permit Expires 1 Year From Date Issued Date Issued __....._�-..G... 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 Ordin ce No: 549. . a a ' AND LOCATION---- �- ~1 JOS ADDRESS j�' ''�j� Owners Name.- tl--940 ---------- -----0�1 - -- -•----•----•-----__-. Phone.-•---•--------•------- _ - •------------• --- -- ------------------------ ------------ Address........................ .. .0. ..--- --- A ---- ----�----!-- .-` •�--....__ ........ Contractor's Name... .................... Phone..................... ---- -- ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/- Number of bedrooms =R- Number of baths .�_._ Lot size -_----%5 ________________________ Water Supply:Public system 91--community system ❑ Private ❑ Depth to Water Table. ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑f Clay Loam ❑ Clay ❑ Adobe ffl--I•lardpon ❑ f Previous Appiication Made: (If yes,date-------------------_) No New Construction: Yes ❑ No gal"IFHA/VA: Yes ❑ No ❑ �V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w e� To �C: Distance from nearest well_________________Distance from foundation--------------------Material............................................ ..... No. of compartments-•------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------.. Ir Disposal Field: Distance from nearest well Distance from foundation_,/fQ__�__.._._.Distance to nearest lot lire-__s,. ........ Number of lines_________ Length of each line-----------�Q...........Width of trench_____a ./...�................ Type of filter material.—a-%— .__Depth of filter material____S-��_-...---To#al length------------_---------Y"' �........ it: Distance to nearest well----------------------Distance from foundation................'_.Distance to nearest lot line................. } Number of pits----------------------Lining ri�aterial---y •-------------Size- Diameter............. _._.._..:Depth------_------__=-----...._....... Cesspool:' Distance from nearest well_________________Distance from foundation._.__________.-__-Linirig material _______. -________.__..___.__...... s... _,,., Size:•piameter De th F Liquid Capacity ------------- gals. ❑ P q p tY - ____Distance from nearest building Privy: Distance from nearest well-----------------------------•-------- - - - g------------------------------•-----•---.. ❑ Distance to nearest lot Eine - ---------------------`----•---•-•--•--•---••--------------------------- Remodeling and/or repairing (describe):__ -•- 1 f. 1 here `:cert y that I ve prepared this application and that the work will be done in accordance with Sao Joaquin County ordinance to a laws, a r les and,r ulations o^ f the San Joaquin Local Health District. (Signed)--•-- --- - ------ -- - -- { rear end/or Contractor) - --- ------------------------------------ rifle__-- BY�---....----•-••-•-•••--- --------------------------- - ----- ---------- { ) r - (Plot plan, showing size of lot, location of system in relation to ildings, etc., can be placed on reverse side). FOR DEPAR NT USE ONLY ,APPLICATION ACCEPTED BY------------------------------------------------------- - .. DATE 1:� r ----------------------------- REVIEWED -' p' "" REVIEWEDBY--------••------------- --•--------------------------------------------------------•---•---------- -------------------- DATE------`-----------------•--•------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------• ---------. DATE ------------------------------------ Alterations and/or recommendations:____.-________________________ ___ __-_-_-___---...____ _ ----------------------- ----------------------•------------------------------------- ..--------�•--------••• .----------------------------------------------.....--•---•----------------------•-------..... FINAL INSPECTION BY:--- -- - - ------- ---- Date------- --Z ..............----------- .....••---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 91h Street Stockton,California Will,California Manteca,California Tracy,California ES 9 REVISED 8.99 9M 3-61 ATLAS