9928 - Laserfiche WebLink

Home Browse Search

� fAPPLICATION FOR SANITATION PERMIT Permit No. _.__��___� . /,14 I (Complete in Duplicate) Date Issued A lication is hereby made to the San Joaquin Local Health 'District for a permit to construct and install the work herein described. Th sapplication is made in compliance with County Ordinance No. 549. e-K, JOB ADDRESS AND LOCATION.- 1,41le.------�-----------�------ - ------- = Owner's Name - � 1Phone____.----------------------------- ------------- �._., . . �. - ----------------- Address-------------- ----� ------------��--------------- - ---- -----------•---------------•------------------•---•----------�-------------- Contractor's Name Phone: Installation will serve: Residence Apartment House ❑ Commercial F] Trailer Court ❑ Motel ❑ Ocher E] Number of living units: __ Number of bedrooms _ Number of baths _ Lot size __. -- -- --- ----- 1 . Water Supply: Publicr system; Community .system [I' Private ❑ Depth to Water Table _�� ft.y Character of soil to adepth of 3 feet: Sand ❑ Gravel ElSandy Loam F1Clay Loam ❑ Clay ❑ Adobe Hardpan E] Previous Application Made: Yes F] 4 New Construction: Yes 0 No ,� FHA/VA: Yes El No I TYPE OF INSTALLATION AND SPECIFICATIONS: ` ° (No septic tank'or`cesspool permitted if public sewer is available within 200 feet.) i Se n : Dstance'from nearest well_____.___:-------Distance from foundation---------------------Material------_e.___________.________--.___-_______:_- No. of compartments----------------- 'Size------------- •----k----------Liquid-cle th----•-------------------'-Capacity--••------------------- `�Dis sal Field: �ufabnece Erol n nearest -ell--+_ MADistgance from foundation__ _____Wiclf ce to nearest lot line_frf�__.____ p __ __ •'• "_._ ____Len th of each line---------V _ Width of trench______. Sf,-- ------------- 1/ 7 ___________ Type of filer material____-- p g .� De th of filter. material------- _Notal length Pit: Distance to neares} well__ _k `-Distance from fou ation___.� ___..Distan�P to nearest lot De ��- - �j e pth----- •-" -------•--- mbe `F Nur of pits-.---/ material Size: Diameter � _-- - Cesspool: Distance from nearest well____:__ .__ Distance from ,f61und�on._.._._-- --______Lining material_____________________________________- ----------- Liquid. --------•-----------------_gals. \ 171 Size: Diameter---- ------ ------ — -----Depth-- ------------------. . - d X . . Privy: Distance from'nearest well_________________ __----------.____----------t -Dlstance from nearest building.___________________:_---------------. ❑ t 1 ------ ------------------------------------------------------ . -.. .,..,...�.Distance�to•nearest lot�lme'----- ----------------------------- -: --•--------- --------- -•------ -- Remodeling and/or .repairing "describe)______ _________ :�---------.- - - ------ __ ___ - L F.{J( ____e___ _ may, _ _______ ------------------- ! hereby certify that I have prepared this a ication and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, an ules and regula ' ns f the San Joaquin Local Health District. i -----_- wner and/or Contractor s .. r -� - ) 3 (Signed)------------------ ; $y=------------------------------------------------ , � -----•-------[Title) (Plot plan, showing size of lot, location of.system in relation wells, buildings, etc., can be place on reverse side). ° r FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY_ __ _ _________________ }---------------------- -- DATE '--------------------------------------- REVIEWED BY'`}--------------------------- _' DATE - �- ---- ----- --- ------------------------ -- DATE-------! f BUILDING PERMIT ISSUED --------------- Alterations ------------- - —r � f� Alterations .and/or recommendations:-------------------------------------•------------------------------------------------------------------.__L --------------•---------••-------•------•-•- + I -----•-------------------------------------•----••---•--------------------------•---- �' a ------------ ---------------------------------------------------------- ----------------------------------- -- -- '; ---------- -- ------- -- -- -- - °----=�------- -------------------------- -= 1 --- ------------ . ----------------------- ---------------- 'loll -- Date---------- ---"` . ------,� •-=- -- - �. ?' FINAL INSPECTION-BY-=---- -- --------= •.----=---= -=--- ------- -- - � -------=--=--- -- 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 1-57 F.P.Co.