5244 - Laserfiche WebLink

Home Browse Search

f S APPLICATION FOR SANITATION PERMIT Permit No. p _ / /1 J) (Complete'in Duplicate) Date IssuedVn'desc?ribed. Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he This application is made in compliance with County Ordinance No. 549. -JOB ADDRESS AND LOCATION-------- ------------------------------------------ Owner's Name----------. = - ------ ------- -- - ----- ---------- - --------------------- Phone Address--- ... -------- -- --- Contractor's ' y� r � Contractor's Name...... '• �1--C�`i .--- - ------------------ he---- Co r Qf ei Installation will serve: Reside e Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑f Other ❑ Number of living units-�._ Number of_bedrooms �- Number,.af.baths _, _,Lot size __.____ _-__d_- r_-� Water Supply: Public systemjj�munify system ❑ Private ❑ .Depth to Water Table _- ft. ! Character of soil to a depth of 3 feet: Sand ❑ ravel ❑ Sandy Loam ❑ ay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS::— - -- - - (No septic tank 'or cesspool permitted if publiq sewer is available within.20D feet.) Septic Tank, _ Distance from nearest well ______-___-_/—Distance from foundation-------------_______Material-----------------_---_-________-_____-_.__-___. No.'of compartments---------------------------Size---------- -------Liquid depth----------------- --------Capacity---------------------- DispossalalFil eld: Distance Arn nearest well---------________.Distance from foundation--------------------Distance to nearest lot line......^_________ umber of lines------------------------------'----Length of each line-------------------------------Width of trench----.------------------------- --- Type of filter material-------- epth of filter material__--_'________-_ Total length_____________________________________. i _ f • r Seepage Pi Distance fa Weare well______.__t_Distance�rom foun fion-r,�_U________-Distance nearest lot line____Z- ____ i Number of� pits._ _# c___-- Lining material__ me__ _ sS ze: Diamefer_�k__-___----Depth__-_--X�__---------- f Cesspool: Distance from nearest weil-__________' __-__Distance from foundation____________________Lining material-------------------------------------- . C� ❑ Size: Diameter--------------------- -----------'___'Depth------------------------ -------Liquid Capacity--------------------- -gals. Privy: Distance f&m nearest well-------------------------------------------------Distance from nearest building- __------------.---------------.+� ❑ Disfance to nearest lot-line----------------------__ = F LL Remodeling and/or repairingdescribel �------------- � �c+t_ '1 Q # .I it ----------------- --------=----------------------------------------------------•----------. " ` ---d•---••-•----- ----- ------------------=---------------- -- --------------- -- I i-- ----------------------------------------------�----------------•---- ______________7f�ha+-+he _________ r _ ____________________________________________ k I hereby certify that I have prepared Phis application awor will be -----done in accordance with San Joaquin County ! ordinances, State laws, and rules and regulations of the an Joaquin Local H Ith District. ,k I A (Signed)--- ..... ' " f' (Owns and/or ontractor) 3 •tl i`` --- GS --- ----- --- BY� ......'I ---------------------------•-----------------------------------------------------------Title------- (Plot plan, showing size'of lot, ,location of system in relation to wells, buildings, efc., can be placed on reverse side). j� FOR DEPARTMENT USE ONLY- ,1 APPLICATION ACCEPTED BY------------ ' -------------- -----•---------------- DATE-------- - --- .,.--�- -- ---------- i DATE ------- ----- ------=------•-------- = - == =---------=--==---"--- �`-- ----------- BUILD NG PERMIT ISSUED----=_M-------------------------------------------------------------- --------------------------------- DATE ------------------------------------- Alterations and/or recommendations:- -------- ---------- -----------------=---=----'_------•----=--=-----------•-----------------------------•-------------------------------------- ----------=---------------------- �€ ----------------------------------------------------" • 1 --• -•----------------------------------------• --••------------------------------------------------� -------------------------------------------------------------- ------------------------------ .__-_____-_-___- __.._--------------------_------_--------------------------------------------------------------- A n i FINAL INSPECTION BY:_____u �h--------------•' ----- -��-----------� Date- -----------------------�,------�L�------ ---------•------------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamoreet 814 North "C" Street Stockton, California Lodi, California Manteca, C.+ter,rnia Tracy, California J ! ES-9-2M Revised W-2100 f