4951 - Laserfiche WebLink

Home Browse Search

APPLICAffON FOR SANITATION PERMIT Permit No. 4.__ --------..( (Complete,in Duplicate) - V Issue - ---� Date �_��,.� Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is mayide in compliance with County Ordinance No. 549. t ! 5 / } /J JOB ADDRESS *LOAT ... --------------- - -_--- --- �- ----- Owner's - ---- ------- c1ae------- --------------------- -- ------- - ----- Z�/ . Address--- Contractor's Name----- ------------ ----•--------•---- Phone---'j�40 _•2"� i Installation will serve: Residence v�_�Partment House ❑ Commercial ❑ Trailer�Courf ❑ Motel ❑ Other ❑ i I-- Naber of bedrooms _ Number of baths -" Lot ____ �_ Number of living units: - as Water Supply: Public system ❑ Community systema❑ Frivate [B<Depth-to Water Table '3_�_ ft. " Character of soil #o a depth of 3 feet: z Sand E] : Gravel E] Sandy Loam E] Clay Loam El Clay E] Adobe [L'Hardpan ❑ ` Previous Application Made: Yes El No � New Cn`strucfiion: Yes �No t ' - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permE##ed if public sewer is available within-200 feet.) lJ Septic Tank: Distance from'nearest well--_r.__ __ Distance foundation__.14:_�d- .Material~�_-_ __________ + Y ; No. of compartment,------- _--, :size_ _ ' _Liquid depth-_'_� ..----------Capacity__.-" ------------ _ r_- <, Disposal Field: Distance from nearest well 4:�- r `--Disfance from foundatio �B-" "_ -Distance to nearest lot line ---------- Number a .:.-_'Len fh of each line_ -06-- — french---- -------------- p I- oi_lines,. : , - ; Width of trench. � -------"----- (fV �De th o T e or filter material_ ____ _ g See a e Pit: 'Distance to,nearest well r1_.- _'-- "" p f filter material-_ _______#_____To{al length___-_ __ D Ty + p g Number of: its.___ ._: Lining �D'stance from .foundet.ion___........_'.___.Distance to nearest lot line_________________ p material__ -_____:__ i_ Size; Diameter__.°__ -.___. Depth_ ..._..___ 3 - ___ __ Cesspool: Distance`.fromnearesty`ell '`. istancfrom'foundation __ __=-_-_.Linin material--------------------------------------fi 1 v . ❑ Size: Diameter-_ =. �.'_ _Depth -- -7--------------------------- -- - ' i uid Capacity- -------------- - ----galsl } q ^, Privy:, Distant rom nearest well-.--------- ____ ______ Distance from nearest buildin -------------------- Distance to nearestlot line__--" ' , Ye Remodeling and/or repairing (descrihe). --- ---_----- - _ ------------ ---------•------- ------ 1 -----t--'- I -_---T--------------- r-"�-- ---- ----------- _ ------- -----------------------` - t o - -------------------------------------------------------------------------=-------------------------------------------------------------------------- I 'r I hereby certify that I have piepare' #his application and that the work will be done in..-accordance with San Joaquin County ordinances, State laws, and rules and regulafiions of +he San Joaquin Local Health District. I (Signed)--- - --- I _ ---------- ---------------------------- er and/or Contractor BY: -----Y,,/---((o C*s� ------ ----- (Ti#le) oZ w (Plot plan, showing size of lot, location of sy em in'relafiion'to wells;`buildings, etc., can be- placed on,reverse side). FOR DEPARTMENT.USE ONLY. ` APPLICATION ACCEPTED BY_ E -" - --_ _-- - -)- --- - - --- ` EQ . -- _ DAT BUILDING PERMIT -SSU --------------------------- --------------- ----------------------.. DATE_-. ED------------- -------------------- -------------F----------•----= = j----------------------- DATE-------- t Alterations and/or racommendations:--.-----------------------------,_.------------,-- ---, r . :: .. - - ----------•------------------------- ------------------------------------------ -------- ----------------------- -;..,. �,v a I ------------------- ---------------- - --- -- --------------------- ---- -------•---------- FINAL -INSPECTION BY:----- -----....--- Date.- r '3v -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reef 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100 a