SU0010486 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit NO. ...la_3S (Complete in Duplicate) Date Issued This Permit Expires 1 Year From 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 applicatiowis made in compliance with County Ordinance No. 549. .* 530 Z- ' / . ........... t JOB ADDRESS AND LOCATION Phone...... Owners --- , nr Address......... _.._ -��------ ...._.. _....----•............. Contractor's Name-�-- x...cr-----------------------------•------�.......................-.................................. Phone.............•--.........-•-....... Installation will serve: Residence I-] ApartmentHouse Commercial ❑ Trailer Court ❑ Motel ❑ Other t + 1 Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size ••--•- .. .-- ----------------- Water Supply: Public system ❑ Community system ❑ Private J) Depth to Water Table S�o ft. Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan❑ , Previous Application Made: Yes ❑ No New Construction: Yes M) No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weil_.�V------Distance from fopndati�on_ ./ '�ry Material-- ----------- No. of compartments-.--- Size .fs---r +q 'lJiquid depth___�/-.•--.----•----•--•Capacityee'r: --•• Disposal Field: Distance from nearest.wel!_ P .....Distance from foundation..J_P..........Distance to nearest lot �( Number of lines...._+...-. - ------Length of each line___j. ................Width of trench_._� ----------------------- T` Type of filter "mat'- -- Depth of filter material-__I If length...-A Q7R_�. ----- r• ' r p Seepage Pit: Distance to nearest,w 11,..1 .____....._Distance fro oundation____1 --'d'__..Distance to nearest lot line: ..-----Size: Diameter---- -8"---.....Depth.. . '__..._ Number of pits_�;�'`-------------- Lining material_ _ "' Cesspool: Distance from nearest well-----------------Distance from foundation---------...........Lining material................................_.... Size: Diametecf I ❑ Liquid Ca ----..-_-_.gals( .:�-----•--••-..-•.................Depth--------------••-•------•-----------...-----•-..__--Liq PacitY-•---•--•----.... Privy: Distance from nearest well.................................................Distance from nearest building-----------------------------------_...... ................................. C1Distance to nearest lot line............................................. ... ------------......-----............_--------•- Remodeling"and/or repairing (describe):.......... .•...-••--•-------•-• --------- .................................................. ........-......................... ................................. N ........... ..•........................- ---.••-•........---•-••-•--•----------- -........................................................ ...__.._... C -: I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Coun{y ordinances, tate law and rules and regulations of the San Joaquin Local Health District. ................._______ (Owner and/or Contractor) (Signed) ' By:._... =:. (TitleJ-----•---••••--••••. --"-------• ........... •. .. (Piot plan, showing si of lot;location ,of system in relation to wells, buildings, etc., can be placed on reverse si e). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY: --•: DATE--9-----L�............... ..--..... REVIEWED BY..... --------------` = ..............................-•-----.----•---------- DATE---•--•----------•--- BUILDING PERMIT ISSUED--==-='- =--'. . .......---....--•-••-••----•................----•••...---•-- DAT E-------•----------------------•--•--------------••----..----- - •-----------------------•----"-----------------------•-•----•-•-•--..-.....--= ---- A{teretions and/or recommendations:......:................................................. ........... .................••---••-••--------•--...�s...-----•••-•---•..........---......_.........-•---••........._...._......--------•--- --.......-__...-------• ...-•-----••---.....---••-----• -- v1ft-5;" --- ...FINAL INSPECTION BY - Date.. fi 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. ,,