18391 - Laserfiche WebLink

Home Browse Search

0v FOR OFFICE USE: V, i+" ,*APPLICATION FOR SANITATION PERMIT Permit No. 4-G'_ i [Complete in Duplicate) ,� Date Issued ___-_�.__ Application is hereby made to'�. � This Permit Expires 1 Year From Date Issued pp y '�tfie an'Joaquin Local-Health District for a permit to construct and install the work herein described. This application is made in co pli-6nce,Fwith County Ordinance No. 549. w: - . / OwBerApNamSe AND.LOCA'7kON Phone-_ '-�_y�--- J ---------------------- / ----------------- ,p - - � Address---- � Phone.ti Contractors Name--------at Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j--- Number of bedrooms __/_ Number of baths -/__ Lot size --/ -- ! Water Supply: Public system ®--c-,ommunity system ❑ Private ❑ Depth to Water Table �t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E--"Hlardpan ❑ Previous Application Made: (If yes,date--------------------) No ®—New Construction: Yes ❑ No [ - SHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 044i' ank:• Distance from nearest well-----------------Distance from foundation---------------------Materia------------------------"-------__-..-.._.__.-_. f No. of compartments Size--------------------------------Liquid depth--- ---------------- ---Capacity---------------- ----- Disposal F- Distance from nearest welI)Ze -0-_Distance from foundation.._,'3_4-"..---.Distance to nearest lot linee----t ----_-_--- 1 Number of lines--------- _____ __ Length of each line---_�U----------------Width of trench-----_tet/-------------------- Type of filter material"-7! Depth of filter material---_ .___-----Total length-------------------"----_.-�----------- 7 Seepage Distance to nearest well- --"Distan m f undation-- _-�--_Distan to nearest lot line--- _�___ J li -.Size: Diameter. 110, Depto `S - e Number of pits---.-._�----.-.___--Lining material- -- - --------- - �� -- 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)---------------------------- t, . ---------- ----------------------------------------------------------- J f ? ---------------------------------------- ---- ----- - ----- --- - --------- - -------------------- ------------------------------------------------------------------------------------------- I 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, Stat aws, nd rules a d regul tions of the San J quin Local Health District. 3 Signed ---------- ------- wrier and/or Contractor) (Signed) - . . . ------"- Title By:-------------------------- -- --- - g P ) (Plot plan, showing size of lot, location of system in tion to wells, buildin s, etc., can be laced on reverse side. FOR DEPARTMENT USE ONLY fM APPLICATIONACCEPTED BY--- ----------- -./P --------------------------------------------- DATE------- /------ ------------------------------------ , REVIEWEDBY------------------------------------- ---- ---.- DATE------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------- --- — - - ----------:-------------------------- - - DATE i Alterations and/or recomme ati ns: -l_./f:Pf -- -.-- ... ------ --- i t l_-'- --------------------------------------------------------------------- 'L .r 1----------- =------------ .......... - ----------- ------ - FINAL INSPECTION BY:.--- --------------------------- - ------------- Date.---/-` -.-�'�'.`3' - ------ --------------- �. SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street ( Stockton,California Lodi,California Mantecar California Tracy,California 4 4 �