2822 - Laserfiche WebLink

Home Browse Search

4�4 APPLICATION FOR SANITATION PERMIT ermit No. .....?_:..-Y (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. S49. JOB ADDRESS AND LOCATION-------(-I-l------------09 °---------- ... --6----------------------------------------------------------- Owner's Name-- 6------ m-'-------- = t--------------- ------------------- Phone_�6,_ /..../---------- Address € �.�- / " -:60—•----------------------------------•------------------------------------------------------------------------ Contractor's Name--------------�� r- a yv-•-►o---&A-0,10 ` Phone_�_x�a Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ xNumber of living units: -1---- Number of bedrooms _.3- Number of baths __-/__ Lot size ___ _�1__a .�3--Q__________________._ Water Supply-I : Public system Community system -E] Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No I New Construction: Yes 9 No ❑ \ TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5 Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material____------_____________-_____________-__- -__. ❑ No, of compartments--------------------------Size------•-------------------------Liquid depth----------- --------------Capacity---------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_____________--_ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-------._----------_-------------------' a Seepage Pit: Distance to nearest welL______� '�_______Distance from foundation______ __.Dista �to nearest lot line____�L_�___. Number of its-------- ! '- _ -Size: Diameter------- ----_..Depth---- -- ------------- p �-----___--Lining materia �- �- - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------___--_--____________-____ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity.---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------.---------------------------_ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------- ; .o_41-40 ° --" I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- ---------------- ------------------------------------------------•------------------------------- -JOAler and/or Contractor) - (::;BY. ---- --- --=� --- " -----------------------------------------------(Title (Plot plan, showing size of to , location of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --- ----------------•-•......--__.-•-------------------------------------- DATE_ --- --------------------------------------------- REVIEWEDBY--------------------------------- - - --------------------------------------------------------------------------- DATE------ ------- •------- --••----------------------- BUILDINGPERMIT ISSUED-------•---------------------------------------------------------------------------------------------- DATE------------ --------------------------------------------- Alterationsand/or recommendations:------------------------------ -------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------------- ------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------------------ ------------------ --------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- -------------------------------------------------- -----------------------------------------•--------------- r FINAL INSPECTION BY:------ - #E'---- - ----- --------------------- 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 8-51 Revised W-2100