10403 - Laserfiche WebLink

Home Browse Search

1� APPLICATION FOR SANITATION PERMIT Permit No. ___________________ (Complete in Duplicate) `� Date Issued _��1---___46 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. 549. o JOB ADDRESS AND LO ATIOIV- /E,�/K_ i�/ --r----------- ---------------------- Owner's Name--------- fi/-4---------- l ��--------•------------------------------------------------------------ -------- Phone--------------------•--------------- Address---------------------- ", Q Contractor's Name-------------------------- --------------------------- PhoneI . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ --- Number of bedrooms -;Z--- Number of baths I--_ Lot size ------- ___________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table s ft. Character of soil to a depth of 3\feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [] Clay ❑ Ado e ❑ Hardpan ❑ 'r Application Made: Yes No New Construction: Yes No FHA/VA: Yes ❑ No PreviousPP ❑ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -,(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) �i6 } 4k, Distance from nearest well_________________Distance from foundation-------------------Material-_-_-__--______._____--______________________._. V 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----------------------- ota€ length-_-____-____________._-______________r 5eepa ' P' : Distance to nearest w I____ � __Distance fr m foundation__ :_____.Distance to nearest lot lined _______ [� Number of pits---------- --------Lining material-----_ /�_-Size: Diameter_-��`�___ -__Depth--- --------------------- `Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material______._______________--------------- . ❑ Size: Diameter--------------- ---------Depth------------------------------ ---------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building _______-_____________-._. ❑ Distance to nearest lot line-- ------- ------------------------------------------------------------ ---------------------------------------------------------------------- Remodeling and/or repairing (describe):----- --�'. ® -•--- t __4--------- �----------- --- ------- ------ I hereby certify that I have prepared this a ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, an s an egulati s of a San Joa%uin Local Health District. (Signed)--------------------- -- ••-- -------- °---- ---- - ----- A- (Plot Owner and/or Contractor) v gY=----------------------------•-----------------------------------�----------------- ---- --- - -- - --- ------------------(Title)---plan, showing size of lot, location of system in relation to wells, buildi g etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ---- -- ---------- --- DATE I -- ------------------------- ---------------------------------------- REVIEWED BY----------------------------------------- -- -------5! -- - - DATE BUILDING PERMIT ISSUED--_--------------------- �--- -------_---------- ---- DATE-----`-�-------- Alterationsand/or recommendations-------------------------- ---------------- - -------------------------------------------------------------------------------•------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------- ---------------------------•------------------------------------------ ---------------------------------•------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:.. SA Date � -- 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 E5-9-2M Revisea 1.57 FP-CO.