5054 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. . -_ _ . {Com(Complete in Duplicate) pDate Issued --- ---15 Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work"herein described, 3 This application is made in compliance with County Ordinance No. 549. t ! JOB ADDRESS AND 'LOCATION------ {� i _�_ .1�. n ------- - ---- - - - - il�tidwr *----- Owner's Name= _ 391_ _x. IAk- ------- -.. Phone_ a Af -# Address-------------------- ------------ :.' �...' Contractor's Name---- k --- p 1ta = ------------------------------- Pho ------ Installation will serve: Residence Y-=Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # Number of living units: 't----- Number of aedroom`s --% Number of baths Lot size __��-�--�►--------*0_4-4 t - Water Supply: 'Public system ❑ 'Community.rystem ❑ Private g- Depth to Water Table#e ft. Character of soil to a depth of 3 feet: i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob;j, Hardpan ❑ Previous Application Made: Yes ❑? No X New Construction:-Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic.tank or cesspool permitted if public sewer is available within 200 feet.) it T k: Distance from nearest well___.__-_- - Distance from foundation ___-----------------Material_-____._________________ .: No''of compartments--------. d.w---- Size ----.-------------- Liquid depth--------------------------Capacity------- D Distance"from nearest well________________'Distance from foundation---------------------Distance to nearest lot line_--.-_-__________ Number of lines---------------e-------------------Length of each line------------------------------Width of trench-------------------------------- Type' of filter material' ___.,___ _______�Depth-of filter rnateriaL_______________.-----Total length____.________________--._________________ Seepage Pit: Distance to nearest' I _--___._ -.Distance`fr m foundation_ . Distance to nearest lot line_________ Number of pits__=�______________ ining material Size: Diameter__ 3r` Depth- ,3- -------- 2►.IT---- ------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------_lining material---------------------------__________ Size: Diameter Depth ❑ - ---- P -- ------------------------------- Liquid Capacity----------------------------gals. Privy:t Distance from nearest well.......- _______________________________Distance from nearest building---------------_______--_______________._. ❑ = ----- ---------------=-------------------------------- • � Distance to nearest loft'line-": �-� rr� � Remodeling and/or repairing (describe)-------------------- - ----------------------------- --------------------------------- ---------------------------------- -_- ----- ---_- - -------=------=--• _ ri 4 -------------_--------.--------..__--__________.-------------------__---------------------------y__________________ hereby certify, at I have=prepa d this appli ation-and that the work will be done.in accordance with San Joaquin County ordinances, State la d rules and r gulati o they San Joaquin Local.Health District. I - [5igned)---------------------- �.• � - '' --- ---- +iL ---- ---------=-------------------- C ntractor) BY: ---_-------------: ........: ----_---_------------=-=---- ----- --- �.l J-Df(Title)_(Plot pian, showing sizE3 of lot, location*vf system in relatio wedings, c., can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATION REVIEWED BY_ ACCEPTED BY-- --- ----- -- --- r .---------------------••----•---------- ---- -=--1--,-._-_-:DATE---------•-•------ ----------------------------------•---- -=------------------------------- -------- DATE__ .,._ _ '.'.� .- = -BUILDING PERMIT ISSUED---------------,f.. --------------------------------------------- _-------------------.- DATE Alterations and/or.recommendations:----`---------------------------------------------•------------------------------------------------------------------------------- ---------•------------ Jj - � j � ___________________________________________________e t-_.._-_-.._-__-,.-___.__..._________________._______________-_-_-.-_____.______-.»._.-...________--•________-------________._ ________________________________________________________________________________________________•____--_._-,._..____-_---._..-.______-..._..._ ------------------------------------------------------------------ ------------•-- 3 f. t "--- -----FINAL-INSPECTION BY: -� � 7_ Date-------- r 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 Revised W-2100