5343 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit NoiJ~-. (Complefe in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC. TION_____ , a -- -0 -- - 0 00 - ------------wner ---•----•- � --• •- /A— - ----' -------• Phone ---------- -------•-- -------•••----- Contractor's Name - - •• -------d; ---- 77"� .__. PhoneQilo_CS ly Installa+ion will serve: Residence Apartment House ❑ Commercial [� Trailer Court • Number of living units: __.l_ Num er of bedrooms . I ❑ Mote! [J Other ❑ 1- Number of baths 1_ Lot size ____0 Q• Water Supply: Public sysf�m ommunity system ❑ Private 0, Depth to Water Table ' �c�ft. Character of soil to aldepfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ lay Loam ❑ Cla Previous Application Made: Yes ❑ No New Construction: Yes No y Adobe ardpan ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Se tic T n p� k: Distance from nearest well________________Distance from foundation__________________-.Material________________.______-_ Jo. of torr,partmenfs----------------- -fie__ ---Liquid depth.------------------------Capacify----------------------- Disposal Fi Distance from neart well_?�isfance from foundation_ -__._Distance to nearest lot line Number o7 - --"" Length of each line---- -3 .- Width of trench.----- -----------------Type of filter materiaLc_ . _ Depth of filter material_/_�._��_ Total length---------- - ` See a s. r p` ge Pi Distaste to nearest well_/�l __��s � Distance from oun atron___.• Number of its s -----Dr lance to nearest lot iine._��-""-_• p ______Lining materral__l" $ize: Diameter___ Depth -_ - --- Cesspool: Distance from nearest well_______________ Distance from foundation___.______-_----- Lining material________________________ ❑ Size:�Diameter---� --�------- ------- ----------Depth- -------- ----------------- - - Liquid Capacity----------------------------gals. . C Privy: Distance from nearest well___________________ '. , Distance from nearest building ❑ Distance to nearest lot line----- __---- 9 ------------------------------ ---- --------------- -- _1 ----------- -- ----- - -- Remodelin and/or repairing- ----- i 9 I (describe):___-_--- .� A --------- .. 1% ---•---- ---•- —%.rte'_._ Q . --•------- ---•------- ----------------------------------------------------------- --- - r ------------------------------------------------------------------------ ---------------•------------------------------•--- I hereby certify that I have prepared this application and that the work will be do in accordance with San Joaquin County ordinances, State laws, nd rules and regulations of_the San Joaquin Local Neal h Disfricf. (Signed)._--- j .a - - ----------- BY� •---!_-� _ ........ \ - C nfracfor) �Owner- -------(Title)---------- of pian, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- > F REVIEWED BY -,%�' DATE r ---- --- ----------------------- --------•-------------- DATE----/- `� BUILDING PERMIT ISSUED______ f 4W_ i ---------------- Alterations and/or recommendations:__:__ � � • DATE -•------------ ---------------------- ------••-------• - • ---------- i ------------------------------- -- - - ------------ FINAL INSPECTION BY:..____ ( 79(h - Date----------/__T ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, Californial Manteca, California Tracy, California ( ES-9=2M 10-52 Revised W-2100