10943 - Laserfiche WebLink

Home Browse Search

4 11-1 1 - , so 1 APPLICATION FOR SANITATION :PERMIT Permit Na. %_�_ 2 {Complete in Duplicate} ��k ST Date Issued r_______-�f Appkication is. eby made to the San Joaquin Loeal'Health District fora permit to construct and install the work herein described. a lic is made in compliance with County`Ord ina ce No 549, JOBADDRESS AND LOCATI - -- ----! ------ -- --- - -------- ---------------------------------------------------------,------------------------------�, /,f/ ------- -- Phone--------------------------------- Owner s Name-------------- r - --------------------------------------- ------------------------------ -------------,.-I- -------- _ __ 7 ' ------- Contractor's Name------------ ' Phone --- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ Number of living units: -�_-_ Number of bedrooms_. Number of baths _01, �_ I_ot size �--- �------•---------- Wafer Supplys, Public system ❑_ �Commun'ity system ❑ private �epth to Water Table __ ff Character of soil to a depth'of 3 feet: Sand ❑ Gravel E] Sandy Loam [I Clay Loam ❑ Clay ❑ Adobeiardpan C] Previous Application Made: Yes ❑ No New Construction: Yes &? no ❑ FHA/VA: Yes �lo ❑ Z�_, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public 14 sewer is available within 200 feet.) Septic Tank: Distance from nearest well' __�- Distance f o� foundaPion_" _ _ Mater�I---- Y _:4-�� -Liquid depth-----, 7 ----._Capacity--��0 - '' �Nyo.,of compartments-- --- ----------- ---size__ =--- �. � ... Disposal 14, Or— Field: Distance-frorn nearest well�P.._____-.Distance from foundatiioonn__��=7 '_-.Distance to nearest let li �-_____- Number of lines." - - Length of each line___-1- - Width of trench.---____._ ______________ Type"of filter materiai. -y Depth of filter material--___line---- ---- ------ length________ _ _,_ -------• �� ".Di cyto nearest to lin -________ Seepage Pit: Distance to nearest ell4_' , �`" Distance f m foundation__ _ __ Number of pits'..__--_-----Lining material_ 1 -Size`: Diam_ eter_-__ Depth-..- --------------- # Cesspool- t Distance from nearest well-----------------Distance from foundation_. -------__y#- Lining material----------------- ---________-------- . Size: Diameter------------------------- -----------Death-------------------------------=-1---------- t Liquid Capacity----------------------------gals. Privy: `o Distance from nearest well----------------'----------------------------- -Di'stance from nearest building-----------_____----------------------_--. ❑ r ;. Distance to nearest lot line �- ----- -=------- '' f �j®� r --- Remodeling and/or repairing (describe):--_/- �' .�`�" _ ' fa � •------ ------------- ------------------ ---------------- --------------- A ------------------------- -------------------------==----------•------------ ------- ---- ----- . „ 1 s rte' --------------------------------- ------------------------------ ------'-`------=---------•'---------------------------------------- ----;� ------ - - -- ------------------__-e w h --1 hereby certify fl at-1 have prepared this application and that+he work-wih be done in accordance with San Joaquin County ordinances, State laws, and rules nd regulations f tke San Joaquin Total Health District. k ~Si g neo � -- - --- - � --------------------------------------------------------- Contractor) t .�� " �. --------------------------- I3 Title} (Plot.plan, showing size-of lot, location of tem in relation.'to wells, buildings, etc., can be pla ed`on reverse side). FOR DEPARTMENT USE ONLY �• APPLICATION ACCEPTED BY------- f - ---------------------- ---- f DATE---------------------------- - ---- ------ f REVIEWED BY---------------------------------- ` J = `} DATE ��/ �� T ---------------------------------------- BUILD:ING PERMIT ISSUED-------------------- 't DA E -' Alterat'ons and/or recommendations:________ �- ---- ----------------- J s -------------------------------------------------------------------------------- .: -------- ------------------------------------------- ----------------------- `� -------------------------- A -_ --___--`------------------------------------------------------------------------------------------------ ----- - --------- ------ - -------- ------------------ _ b FINAL INSPECTION BY:•----------- --------- 0 --- *;Date----- ----------------------------- -; I SAN JOAQUIN LO AC, TH DISTRICT. by } 130 South American Street 300 West Oak Street 132 Sycamote Street; 814 North "C" Street # Stockton, California ! Lodi, California Mian+eca, California Tracy, California ES-4--2m Revised 1.57 F.P.CO.