9462 - Laserfiche WebLink

Home Browse Search

` 1 APPLICATION FOR SANITATION PERMIT Permit No. -.. (Complete in Duplicated � Date issued --��--S--►f.--_.---- - 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 ounty Ordinance No. 5499. JOB ADDRESS AND LOCA ION f--------- .:. ------ -------------------------------------=--- Owner's Name_______ --- -��cJ-- --- Phoneme - .' -- --- Contractor's Address.-------- ---4 7 = - --- Contractor's Name � � ..--_.._ Phone.---• ------1 �� Installation will serve: Residence Apartment Houser❑ Commercial ❑ Trailer Court ❑ . Motel ❑ Other ❑ Number of living units: __/___ Number of `bedrooms ___/ Number of baths ---,(-- Lot size ------ ! j Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table --_ dit. Character of soil to a depth of 3'feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Acloloet Hardpan E❑ Previous Application Made: Yes;El No New,Construction: Yes ElNoFHA/VA: Yes ElNo� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ❑ well M _----__S ` _--__ ____________ ___ _ Nm ------------- ----_'Size------------------------------Liquid depth--------------------------Capacity-•------------------. DispS� d: istance from nearest well __.___�Disiar'Ee from foundation__ . --------Distance to nearest lot line----------------- ' ------ -- --------'Len Length of each dine_' = -- - --------.Width of trench----------------------------------- Type �umbe� of lines_________ � -. } g s I ..�, Type of filter material--------------- ---------Depth of filter material_4'.---------I-�---Total length------------------------------------------ line --------------------------_-,:--------f- it: Distance to nearest well__-_1VOWE Distance fr m foundation_ _ ice to nearest lot ne_.-_--f Dist. JI r Number of its:__.____ - Linin material-----�W1.C.Size: Diameter--- ✓___-_,.---Depth_____ -V Cesspool: Distance from nearest well_____:i__.____--Distance from foundation------------------_-,Lining material__._____________._._________-___.--_ ❑ Size: Diameter---------------------/-Y-----------Qepth------- ---------- -;-=------------Liquid Capacity----------------------------gals, # Distance from nearest b0clin Privy: Distance from nearest well---------------------- -- ----- a 5 ❑ Distance to nearest lot'line---------------------- --------------------------- ---•----•----------- Remodeling and/ repairing describe):------- -- - �r:-------� --------- . -----, ----------- --------------------------------------- ----------------------------••--------------`-------•-=-----------•----------------=------------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 laws, and rulesTand r u lotion of the San J Local Health District. l - - - --------------------- nd or Contractor) (Signed)------------------------------------- ?� _ r. }# ---------cv Title - ---- /- ----- ------ ( plan, g �` 5 y ings, etc.,'can be placed on reverse side). Plot Ian, showing sixe_of lot, location o system In relation to wells, bu' , r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYf` ---------------------------------- - DATE------- 1 -- ---------------------- .,- DATE--- - -...-- ..REVIEWED BY---------------------------�- ----l ---�- -------------- ---------------- ----------------------------------- - -�-�-- •-.--•--••--------------------•- -- • - BUILDING PERMIT ISSUED_----=------- ----- , �----------------------- =f DATE-,/ . �r f 1�r-p Alterations and/or recomrrtend�tion .---�_�._� { �- -----�fe___�t.�t�^±t_t_�----E` �.1�--�'�'� --�---4J.h--L'`---- .4Etl��--�"'-------------------- g = �h_S-. _�l 4 .�c _ ,t a---------------- ---------------------------------------- -------------='---------------- ------------------- ---- ---------------------------------- '.....°fie `.,:.. r 'c�-- `f •U _.. - _....:. -------------------•-------------------------- -------� ----------------------=------ Rate --- ------------------------------------- FINAL INSPECTION B .. -= //// d ) - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sd h American Street 300 Wes# Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M . Revised 1.57 F.P.CO•