9016 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 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. 1 _Y . JOB ADDRESS AN LOCATION_.__ E f - r15 7 cYf --------------- ------------------- -- - Owner's Name - ------------ --------------- ---- -= --- -''`'heti • 'a...,. - -- ----- - ------- --- U'�^r�Gr _..-- one---- - Address_.---------••-------� -•--------------------•--- _12 _ _ __ _ _______ ------------------------- Contractor's Name_____ -__-. -e- 09 " 7a y�6 ---- --- - ..... --- -------�------------------------- Phone-----•--,�/-------•---------- -------- Installation will serve: Res-id nce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: -__- Number of bedrooms __.1- Number of baths I--- Lot size "a_~_.�-.,� Water Supply: Public system ommunity system L-] Private p Private Depth to Water Table I Character of soil to a depth of 3 feet: Sand9., Gravel ❑ SandyLoam ' �� ft ❑ Cls Y Loam ❑ Clay ❑ Adobe [.Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or'cesspool permitted if public sewer is available within 200 feet,) Septic Tank: Distance from nearest well f �T _Distance fro dation" ��_________:Materia!__-Material No..-of�com artments �� !I --- __ _____________ r p �/_----------- Size- ��-- Liquid depth"_ °7-- --------Capacity Disposal Field: Distance from nearest welll (�eRR. _pistanceom foundation_ ____ Number of lines_ _- r� /--------Distance to nearest t line_-___ Length of each line_--/ ' """ Type,of fitter materia!_ `-_--- Width of trench_ -____f__Depth of filter rnatsrial____ ��"___""_Total length____ a Seepage Pit: Distance to nearest well___"_________________Distance from foundation------------.-------Distance to nearest lot line__"__.______"___ ❑ Number of pits___________________L;ning material______"_ Size: Diameter_---------------------Depth-------------------------- Cesspool: Distance from nearest well________________ Distance from found stion--------------------Lining material_-____________________.- ----------- 51ze: Diameter-------- ------- ---- --- --------Depth- - ------- -------- -------- --------- - ---- f � - -- Liquid Capacity. --------------- ---------gals. Privy: Distance from nearest well-_____________________ _ Distance from nearest bO&n ----- Distance to nearest lot line._.__� : ' -----Remodeling and/or repairing (describe):---`--- - -------------- j: -------------•----- -- ------------- -------------------------------- ----------------------- -------------------- ------------------- ---•---"--------------------------------- I hereb rtify that I have.pr pare M. a tion and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rul s 'ndket-ulati of S ' e � istrict. (Sign ------------y -- - ---- - - ---(1`CI----------- --- �1 By:. ------------ --------- ----•- I ontra "or C ) r (Plot plan, showing size of lot, location of system in tion o�vells, buildings, a (Title) ___ ` ----------------- ., can be placed on reverse side). x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_________________ -------------------------------------------------------------------------------- REVIEWED BY-------•------ - DATE_ - ------------------ r BUILDING PERMIT ISSUED---------------- DATE ..... ---------------------- } Alterations and/or recommendations:"_"_- - ------ -----------------------------------"__________ --- -------- T . '- -s' _ � " . a _� --------------- ------ --- - --- -- - f -- -- 1 --- �_ _ FI AL INSPECTION BY:,o, = ° Date I/ SAN JOAQVIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street Stockton, California � 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-4-2M , Revised ;-57 F.P.CO.