4472 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. in Duplicate) 0 � (CompleteDate Issued .-----�-... ------ Application is her y 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 Ordinan e No. 549. JOS ADDRESS AND LOCATION-------------1-7�'� _ - - � - - ------ Q �� "'`a!-- ---Owner's Name---------------------------------------- --l_� -- ---- ----= - .-------------------------------------.-. Phone---------•�-`7 �_ _,-- A ------------------------ Contractor's Name " r ------ Phone------C/:71-4-P-7--- Installation will serve: Residence,_RL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of baths . -/-- Lot size ------ --*Jr_�---- -- - ------------ Number of living units: _--�. Number of bedrooms _'� I -t� Water Supply: Public system ❑ Community system ❑ Private Z_ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe D�, Hardpan ❑ Previous Application Made: Yes ❑ No jg._ New Construction: Yes ❑ No ❑g"ee `Mft-* j%j X9*AA jR TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic T nk: Distance from nearest well--___-._---.--_Distance from foundation-------------------.Material__-____---.---.---_----_--__----..-------___-. r®l No. of compartments--------------------------size------------------------ --- --Liquid depth--------------------------Capacity-----------------------` ield: Distance from nearest well-,6Q_'----Distance from foundation-------1_ .�--Distance to nearest lot line----------------- Disposal I Number of lines-------� Length of each line-----__-�.5''- Width of trench..__a. -"___.-__-----.. Type of filter material----!-�_`�-� .---Depth of filter materia_-.-- -.�f---.-Total length----- J_.�------------------- --� Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.------Distance to nearest lot line--.--_____-----_ E] Number of pits----------------------Lining material-----------------------Size: Diameter--------------------- Deptn-------------- ----------- 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---------------------------- --------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)------- -------------------------------------------------------------------------------------------------------•------------------------------------------ -------------------•--------------------------------------------- -------------- ------------------------ -----------------•----------------------------------------------------------- ---------------------- I hereby certify that 1 ha a pr pa ed t s applica 'on a d A t the work will be done in accordance with San Joaquin County ordinances, State laws, and rul s and egul ions of t le San Joa uin Local ealth District. -- ----- :- --- (Signed) - - (�a+Contractor) bir- B ..------ �-> •. -- - ---- -- ----------------------------------------- - ---------------------------------------(Title)--- 10- f rMIN C2ir�----------------------- (Plot an, sh i g si ez o6ot, loc on I f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- DATE REVIEWED BY DATE---/ .� BUILDINGPERMIT ISSUED----------A---------------------------------•-------------------------------- ----------------- DATE--------- - ------------------------------------------------- Alterationsand/or recommendations------------------- --------- --------------- --------- --------------------------------------- --------------------------------------------------------------- ----------------------------------------------------------------------- --------------------------- --------------------------------------------•--------------- -------- ---------------------...--------------- 47 Z ' = Date ` --� -- ---------------------------------------------------- FINAL INSPECTION BY:. - �.-. 1 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 10-52 Revised W-2100