12024 - Laserfiche WebLink

Home Browse Search

} APPLICATION FOR SANITATION PERMIT Permit No. .j /J_ .: s . g (Complete in Duplicate) This Permit Expires 1 Year From pate Issued Date Issued -____//X-------- Application -- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in cam liance with County Ordinance o 549. -r � - - .� JOB ADDRESS AD�6�LOCA ION__ }� ' QST—(00-0 Z A( ---- -- ------------------ Owner's Na -a .- - - --•--�----- a ------------------------ ---- --- Phone -- Address----- Phona__ _ Contractor's Name-------------------------- T Installation will serve: Residence g?"'A-partment House ❑ Commercial ❑ Trailer Court E] Motel El Other E]I Number of living units: __/-__ Number of bedrooms ._cR_ Number of baths _1__ Lot size ---------------------------------------- Water Supply: Public system ❑ Community system ❑ Private UR-15epth to Water Table ft. Character ofsoil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay F1Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ffr—New Construction: Yes ❑ No [�-- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t' an c: Distance from-nearest wellx'-r'-'_r____-Distance from fountlation=_"^^`_.____.__-TMaterial----------- ______`:`_-_---__---_---__- �- No. of compartments �---Size-----------------------••-------Liquid deptk--------------- - --------Capacity---------------------- /�� Id• Distance from nearest 711- from foundation......jf�1_.---.Distance to nearest lot line-maw__- Number of lines---.-------- -----_-- Length of each line-----13Q_--f_____------.Width of trench----- --- ••--------------- /� Type of filter material-sem Depth of filter material_ _ a Total length • Seepage P't: Distance to nearest/`�ell--fes Q -�_-_-Distant m fo ndation____,5e,0 _�_.D'stpan5p to nearest lot line_el_-. Number of pits-_-_-- 1-----------Lining material_ .Size: Diameter----�p------.---Depth_.._,�-------------------- /C) 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- -------------------------- ------------- ----- ------------------------ ------ 17-0 Remodeling and/or repairing (clescr be]:___- _ a , - - --- ------- ------- ------- -1------------------------------------- - -------------- - -------------------------------------------------- ----------------------- ----------------------------------- -----_--------_---------------------------------------------------------------I----------------------------------------------------------------------------- � y ____________________________________.__-__.____________._______t_____--_____________._____._.____-__________________--_________-__-_________---__-_-._______________-__-_-_-_._____________-____..__________-_--____--__.____._ I herebyPy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sws, and rules and regulations of the San Joaquin Local Health District.(Signed)--------- ------------- ------ { wrier and/or Contractor) 8Y= ----------------- ------------------(Title) I---------- -------- + (Plot plan, showing size of lot, location of systenVin relation to wel uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- DATE-------__--- ------- -•- -- -_-- k - -- ------------ ------------ BY ----- - ---------------------------------------------------------- ------- DATE - ----------------- BUILDING PERMIT ISSUED =---------------------------------------------------------------------------------- DATE---------------- ----- ----- ------------------------- terations and/or recommendations.-,------------------------------------- ---------------------------------------------------------•-------------------- ------------------------------------------------------------------------------------------•----------•- ------------------------------------------------ ----------------- ------------------------------- ------------------------------- ----------------------------------------------•------------------------:_s. ---------•--- FINAL INSPECTIONBY: C. ryr�...��-'-f` ------ Date----- �- '�-rte- ------- --------- ---- - �--------------- 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 E$-9-2M Revised 6-'59 F-P-Co. -