4688 - Laserfiche WebLink

Home Browse Search

Q APPLICATION FOR SANITATION PERMIT Permit No. .... ...K?-_ _._. (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 yOOrd' a e No. 549. -�- /� S-JOB ADDRESS AND LOCATION..JQ73#,°° f - Owner's Name-------' - _---•---------- ---------------- --- - ------- ---- ----- -- -- Phone-- _ 1__"#_ - 2-711 Address.- ��'/ ---------------•--- P� ------------------------------------------------ ----- - f1a �M•�-. �`+.1 ------------------- Contractor's Name------------------------------------------T_ -----� - Phone ' ' -------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court [-] Motel ❑ Other E]a/��. Number of living units: __ Number of bedrooms ,3--- Number of baths _ !� Lot size _--_--41�_& ---------------- Water Supply: Public system ❑ Community syste mX_Private ❑ Depth to Water Table__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No,-,ET New Construction: Yes ❑ No ❑ 47 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-p.2itfed.if public sewer.is available within 200 feet.) ti�,.Ta Distance from nearest well________________Distance from foundation--------------------Material----------------.------------------------ -- No. of compartments------ -------------------Size--------------------------------Liquid depth----------------- --------Capacity..-------------- ---- , ispo�sal.Fisld: Distance from nearest weld-.00 Iistance from foundation---IQ-'_--..Distance to nearest lot line_._'._, to W Number of lines-------I--------------------------Length of each line__--- _._*-.___-.._-_-.-.Width of trench___._-1+_^�._"_.________ o Type of filter material__t "E /G_---Depth of filter material___!-_+ _'__�--_-Total length_-_/ '--------------------` Seepage Pit: Distance to nearest well-'7VV------_--Distance from foundation__/tel------_-_''.Distance to nearest lot-line--_�_____ Number of pits----I----------------Lining material _,_...Size: Diameter--- Depth----/.0-.'--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------_----_. Size: Diameter--------------------------------------De fh _--Li Liquid Ca acit� _--_- alb _: : q_ . ..P _. Y _ 9.. Privy: Distance from nearest well-------------------------------------------------Distance from nearesr building-----------------_----------_-.--._..--.- r ❑ Distance to nearest lot line-------- ------------------------------------- ------------------------------------------------------------------------------------------- /1 - Remodeling and/or repairing (describe)---------- ----- ° -------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------ -------------------------- --------------------------•-----•-------------------•---------------------------------------------------------------------------------------------------------•-----------•------- ---------------------------- C ---------------------------------------------------------------------------•-••--------------...-------------------------------------------------------------•------------ -----------.--------------------------------- I hereby er fy that I have epared this application and that the work will be done in accordance with San Joaquin CounfT oe ordinances Sfaf laws, an �Ies nd reg4sysfein e San Joaquin Local Health District. •(Signedl------ - --- --- -- �- � } -------------------------------------- ------- Contractor By:--------------------------------------------- ------------A/d-- ----------------------{Titie]"� (Plot plan, showing size of lot, location o tion to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----------------------------------- DATE '�..- --------------------- ------------------------------------------------------- REVIEWEDBY---- ---------------------------- ------ --- - -- --------------------------------------------------------------------------- DATE-- BUILDING PERMIT ISSUED------- ------------- - -------- DATE------- ---- -------------------------------------------------------- - --------------------------------------------- Alterations and/or recommendations:------- -------------------------------------------------------------------------------------------•---------- - ------------------------ ...----------- ---•---------------------------•-------------------•------....------------- -------•------------------------------------------------------------------------------------------------------- -----------•-------------------------------- -------------•-------------- ---- - ---•-------------------------- -------- ---------------------------------------------------------------------- _14-1�>e—CIQ FINAL INSPECTION BY:.- ------ Date-------- --------------- --------------------------•-------------------- 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 10-52 Revised W-2100