10844 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT I Permit No. + (Corrtplefe in Duplicate) Application is hereby made to the San Joaquin Local Health District Date Issued This application is made in compliance with County Ordinance No. 549, h l� �sS—p for a permit fio construct and install the work erein described - _ JOB ADDRESS AND LOCATION�-_�--^e--� _ Owner's Name---------------` _l�Ir�t� .vy' f�. �..�.� Address -------- �- e Contractor's Name. r.--- - --- - --- --10 Phone s ; Installation will serve: Residence ----- Phone 3 {] Apartment House � - - ---- ❑ Commercial 0 Trailer Court ❑ Motel Number of living units: _l--_� Number of bedroorris __ ❑. Other Number,of baths -_�___ Lot size T -r'__ �/p ' Water Supply: Public system ❑ Commun'it s st Character of soil to a depth of 3 feet: Sandy y ❑ Private Depth"+o Water Table --ift. - Gravel ❑ Sandy Loam.[] Clay Loam ❑ Cle . No y C1 Adobe C] Hardpan C]Previous Application Made: Yes [] ❑ New Construction: Yes ❑ :No ❑ FHA/VA: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ No ❑ {No septic tank or'cesspool permitted if public sewer is available within 200.feet.} Septic Tank: — -�' p Distance from nearest weli_�_�_ p�stance frorrr foundatio .---"___-' .Material----� -o�••�d ' No. of com artmen#s"-_- �d �>u.,, f p ' Size- __'x_5�--------� Liquid depth----- •------ . Dis Deaf Field: Ca acit -__-- p Distance from nearest well_-_�� e ;,. . _ Capac ��-.--_ I from foundation_ 1� rr.4.__-- Distance to nearest lot line_t__r_-- - Number of Lines---------/9-n` ' , Length of each line-------- --4 ,/' of Type of filter material-----." -.�i_ otal hle length, ll l---------- .. - �Depth of filter material_"- Seepage Pit: Distance to nearest well ---------------Distance Distance from'foundation-_-.._ - ❑ Number of pits__ ___ __________"-_ Lining material_--______----_ -- ••---•----Distance to nearest lot line-"._______"___. ' Cesspool: ---------Size: Diameter----------------- ❑p Distance from nearest well- --------------Distance from foundation_________------._ .Lining ma+erpia�th�_ Size: Diameter--------------- .' --------- On ------------------ --------------=------------------------Liquid Capacity p tY -------gals. :. nvy: Distance from nearest well --_- _ Distance from nearest building El Distance to nearest lot line--------_ ----- g ----- -- ----- Remodeling and/or repairing (describe-------------------------------------------- ------•-- - f ----------•---•------------- -----4 --------------------------------------1hereb certify that I have prepared ----------------- ----- •------ -----:------------------------- ------- - Y Y . - --- - ---------- --•--- -----# p pared this ns application and that the work will h done in accordance with San Joaquin.County ' ordinances, State laws, and rules and:regulations of the Sen Joaquin Local Health District, {Signed)--------- ----- ------------. .. -------- --------------------------- ----------- By:_ ------ (Owner r tract + =----- {Title} and/or Con or)I ----- ------ ---------- (Plot plan, showing size of t, location:'of system in relation to ells, buildings, etc., can be placed on reverse side-- . �. ,. T- = F ,R"IJP T f T USE NLY - � T APPLICATION ACCEPTED BY-----__-- '�-- ' = � REVIEWED BY---•--------':_-- - ------ :�:^►- --- DATE --------------- ---------------------•--------- ----------•------- - ----- - �----------.-- ------•---=-- + • ' DATE-_ --------------- BUILDING PERMIT ISSUED Alterations and/or recommendations:- ------- ------ - - -- --------- -----------------------------------_- DATE-----------•--"-_- -�---,-------- ----------------------------------------------------------------------------- - J ----------- ------------------------------------------ ---- ---------------------- -"-- �fJ --- - --- - --•---•---•-----••------ FINAL INSPECTION BY. f1( Date-- ............................ i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Ma Sycamore Street 814 North "C" Street Lodi, California Mentees, California Tracy, California ES-9-2M , Revises 1-57 F.A.CO.