9955 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 5�._5,�./.. (Complete in Duplicate) Date Issued -----h_ 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. j JOB ADDRESS AND LOCATION_..--1_W_1G1•k`-�---------SPD!! ----------------------------------- -------------- Owner's Name__*_1-C4rjK-<------ hone------------------------------------ Address------------ ------- •--------------•---- Address------------------•------ 1_.. ? yp vx - -•J ---. Contractor's Name_______ �, -- .�4/r !�/�------------ ---------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial I Trailer Court ElMotel [IOther ❑ Number of living units: __.._--_ Number of bedrooms __--_--. Number ofhs ________ Lot size --------------------------.-------------------..____.______ Water Supply: Public system Community system ❑ Private�yoam Depth to Water TableQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ j Previous Application Made: Yes ❑ No New Construction: Yes ❑ NoFHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFTeATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eI a Distance from nearest well_________________Distance from foundation--------------------Material -_--___________-.-_----.__________-------- No. of compartments-------------------------Size-------•-----------------------Liquid depth_-----------------------Capacity----------------------- els Field/: � Distance from nearest wekl__A/Wl_Distance from foundation---A10_0 _-.Distance to nearest lot Ii e� G^ Number of lines---------- -----------Length of each line___ .r-__f -------Width of trench-__._2,___ _.________-0, - Type of filter material___ Ck__--_Depth of filter material----/,'------------Total length.__. .......... --------- "'� from foundation____ 0_d_5_....Distanc to nearest lot line Se ge Distance to nearest weli____��_�_____r___D�stance � �fr � Number of pits--_-____./_----_____Lining material______ o_t/G__-Size: Diameter__. °r"�� ,�� Depth--_, .------------------ VCess ool: 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--------------------------------------- ------- -------------------------------------------------------------------------------------- ---- Remodeling and/or repairing (descrii,e): ---• ------- ` z"' •* ----------------------------------- ---------------•-- ------------------------------- V - ----- -- ----------------------------------------------------------------------------------- I hereby certify that I h e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an u sand regulafl6nisDof the San Joaquin Local Health District. (Signed)--- ---- ---•--- -� p�°� ' '.f" ------------------------(Owner and/or Contractor) By-------------------•-------------------------- - - ------------ ---------- -------------(Title)----- - a^` (Plot plan, showing size of lot, location of system in relation to IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- --------------------------------•-------------------------------------------------- DATE--=�------------------------------------------------------ REVIEWEDBY---------------------------- �--- ----------------------------------- - -- ------------------------------------- DATE__ -------------------------------------------------- BUILDINGPERMIT ISSUED----------------- ------------------------------------------------------------------------------ - DATE------ll`Z�------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------•-------------------------•--------- •------------------------------------------------------------- --------- --------------•-------s- -------------------------------------------- r � - :1 ....... -- --------------- ----------------------------------- -- ---------------------------------------------•------------------------------------- FINAL INSPECTION BY:. . - --- - 't Date.__. ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.A.CO.