5503 - Laserfiche WebLink

Home Browse Search

Permit No. APPLICATION FOR SANITATION PERMIT _✓`____ ____ ______ (Complete in Duplicate) Date Issued Applicakion is hereby made to the Sa'n 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. JOB ADDRESS A D LOCATIO ----4Qrc_� --------�7------ -1Z-6------ ----------------------------------- Owner's Name Phone- � 0 ------ ----- x s - Address---------------- -------------------------------------- ,(- r 7 Contractor's Name-----=.. ----------- -x -u------------------------= ------------ ------ Installation'will serve: ;Residence [4---Apartment House F] Commercial ❑ Trainer Court ❑ Motel ❑ Other ❑ i Number of living units: __ _._ Number of bedrooms _�_ Number of baths -_1-___ Lot size _ _ -_-X 67-C)---------------------------- # Water Supply: Publics stem �Communit system Private Depth to Water Table A0 ft. M PP Y� Y Y Y ❑� ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Cons ction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer s available within 200 feet.) Septic nk: Distance from nearest well_____ .____Dist nce�f rom fo�ntpn__-_ ------- .Material_ __ _.�'` -------------- No. of"compartments__________ --------------Siz Capacity_ f1 ____ . I y ; ` R _�Liquid depth �a - Disposa-Field: Distance from nearest1well-----��_._Distance from foundation__�0_-____-.Distance to nearest lot line----�1�_�____ A N Number of lines___.'_'------ _� _ 1 Length of each line-------- _ ______.Width of trench-_--z9',-Y--_---------------- _ Type of filter material_I _ ._ p A - .., g � �Q� 't Seepa' "Pit: '- ~;Distance�to-nearest well-------'r--------D stanceffroterfouneation__r-_,C�.f-_Diistance tonearestine_ � / r � p . . n � ----------- r ✓ Number of pits--_-. L Lining material_e Cesspool: Distance from nearest well-----------------Distance from foundation__._________.______Lining material---.--------------------------------- Size: Diameter--- '--------------------------------Depth e t -- I--------------------------- 1- --------Li Liquid Capacity ❑ , p F q ---------------------- - ---•gals. Privy:' Distance . new'est well_______$_.'__.-Y___ '�'`: .__ ________Distance from nearest building------------------------------------------ ❑ Distance to nearest'lof line ---- - - --------- ----------------------------------------------------------------------------------- -------------------------- it �. „ Remodeling and/or repairing (describe)----------------------------=-------------------------------------------------------------------------•---------------------- ------------------------------ ------------------ • --•- ----------------------------------------------------------------- ---------------------------1. ----------•---------------------------------------••----------------------------------••----•------------- -•----------- .1 "'t ) ------------------------------------------•--------------------- I - . .t ------------------_------------------_-------------------------_,__s_R___.-------------....................- ._.______________-_-_________._________ I:hereby certify that I have prepared this application and.that the work will-be done in accordance with San Joaquin County ordinances, State la s;and rules and regulations of the San Joaquin Local Health District. (Si ned 9 )•------------- ---------�- -------------- --- ---- -------------------------------------------------------------:----------------- ---------Oaalter and/or Contractor} -- ------ --------- By; = (Title} ------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- ---------- ----------- ---------------------------------------------- DATE '-�- REVIEWEDBY--------------=----------------------------- ----------------------------------- -------------------------------------- DATE------- ------------.....- BUILDING PERMIT ISSUED---------------------------------- ----------------------------------------- ----------------------- DATE----•------•------- .----Alterations'and/or recommendations------------------------------------------------------- ----------------------------------•-------•------------------•------ ---- ------------------ ---------------------------------------:-------------------------------------------------------------------------------------- ---------------------------•---------------------------------=----------------------------------------------------.-----=-----------•-•---------- -------------------------•-- ---------------••-----------------•----- - = --- - t k f Iq� FINAL INSPECTION' BY:--------------- Date.-- _ ` 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 ES--9-2M Revised W-2100