2302 - Laserfiche WebLink

Metadata

Thumbnails

Annotations

APPLICATION FOR SANITATION PERMIT Permit No- ------------------ r (Complete in Duplicate) ' £ ' s. Date Issued 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. 1 `��lJ`✓ JOB ADDRESS AND LOCAT ON------ �� x`- ------------------------- ' a---- Phone-- ! Q Owner's Name--------- ------- -- - -------- - �:. .. -------- --------------------•------------------ ---�------- Address----•----- J T i4 h Contractor's Name � ,.� 9, - -'- - --- ------ --------------------- phone---!'�__ld Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:`- - __ N er of bedrooms _ Number of baths ---)-- Lot size ------ - ---_ --------------- 1 Wafter Supply: Public system Community system ❑ Private ❑ Depth'(to Water Table -------- ft- 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ N6 ❑ TYPE OF INSTALLATION- AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer is available wifhin 200 feet.) z it . Septic Distance from nearest well_-__-____-_--_--Distance from foundation--------------------Material-_-------------____-__----____--_---- ------ 77,,�I,,00 No. of compartments---------- ---------------Size------------------------- - ,!Liquid depth--------------------- Capacity----------------------- •��_ -_-- Disposal Field,. Distance from nearest well--_--___'A'-Distance from foundation-------------1---_-Distance to nearest lot line-__---_--__-____- { Numker of lines-------------- °------- ------Length of each line------------------------------Width of trench----------------------------------- Type of filte lmateri�al ------_€--- ---------Depth of filter material-----------------------Total length-_-__-__----___----__-_--___----___--_-- Seepage Pit. Distan!a to nearest��w,e�ll_ �ll�y__Distance f?J �oundation_/�__._Distance to nearest lot line-- _- -_.---_ Number of pits-__f�'''M--_____Lining material_ Size: Diameter__--f- --�-_-.----Depth--_— v Cesspool: Distance from nearest well_________________Distance from foundation ___.-------_------Linin material------------------------------------- �.. z .❑ � :;� - __ ,_-:___r_��Qepth }-- : ;- ------ -- - ---- -------Liquid Capacity-- - „ gals.Size: Bo mete r' Privy: Distance from nearest well_____.__------------------_--_--_-_-----------_Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line--------------------------- -------- ----------------------------------------------------------------------- ------------------------- Remodeling and/or repairing (describe):------------- - ' I I 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 rules and regulations of the San Joaquin Local Health District. � t Si ned tet- ------- ------ --- ° wt --'-°!"�":_-_-- - Owner.1and or Contractor) r t By Title - '" ---------------- -------- ------------------------------------------------ { ' }-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------ --- ---------�----------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY------------ ------------------�/�` f --- - --------- ----- -------------------------- DATE-- ` M BUILDING PERMIT ISSUED DATE-- ---------------------------------•'---- kAlterations and/or recommendations. -------- ----------------- = ------------------------------------------------------------------------------•-----------------------------------------------------------------------------------------------------------------------..........------------ F -------------------------------------------------------- --------------------------------------------------- •-----------------=------------------------------------------------------------------•------------------------ --------------------------- ------------------------------------------------------- --------------------- ------------------------ ------- -------------------- ---------------------------------------------------- - ---------------------------- FINAL INSPECTION BYG '" :-- Date fl-_-p ------------------------------ 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- 21A -8.51 Revised W210D '