3906 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit N�/3 L o.,----------------------- (Complete in Duplicate) Date Issued Application is hereby made to the! San Joaquin Local Health Dis for a permit to construct and 'install the work herein described. This application is made in compliance with County Orclinan7c /NU49, JOB ADDRESS AND LOCAT 01\1:. -5/7.................. ....... --—----- ------------------ Owner's Name------------- -- ----71----- Ae. ywv---------------- --------------------------- ------------------------- - --- ------ - _ �7 4 - ------ ----1� Address......___..........-------- ------ ------- Contractor's Name_____ --- ----/r XXI4 1V ------------------------------ ------------- Phone._�7 0 7 ------------------------- ------- I Installation will serve: Residence,x Apartment House E]. Commercial [] Trailer Court 0 Motel 0 Other E] F Number of living units: I---_-_ Number of bedrooms..-/---- Number of baths /-_____ Lot size A0e_ - Water Supply: Public system E] Community system'M -R-rivafe Depth to Water Table /_0__ ft_ Characterof soil to a depth of 3 feet; Sand [:) Gravel 0 Sandy Loam El Clay Loam Clay Ej Adobe 0 Hardpan E] Previous Application Made: Yes E] No x New Construction: Yes E] No K TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public,sewer is available within 200 feet.) Septic Tank: Distance from nearest well______._."-------Distance from foundation--------------------Materiai---------------------- -------------------------- El No. of ccFmpartmenfs------------------________Size___._--------------------------Liquid depth--------------------------Capacity----------------------- -Distance from' ndation. line Disposal Field: Distance from nearest well1da, dation.__. . --__...Distance--------Distance to nearest lot -.34-------- ou Number o[ --------Length of each line----11:2) ---------Width of trench-.,,4-*'?----------------------- material---- --0---------------Total Type of filter material:YA"964�_Depth of filterlength_____ _-'_________________________ -------------------------- Seepage Pit. Distance to nearest well------- --------------Distance from f8undafion------------ Distance to nearest lot line-_-------_._-_-__ ❑ Number of pits----------------------Lining material----------------±------Size: Diameter::--_---------------Depth---:_.------------------ ------ ------- Cesspool:- Distance from nearest well-----------------Distance from foundation---------------__.Lining material-_..____--_._---- --------------- 1771 Size: Diameter--------------------------- ---- .---Depth------------------------------------------------ --Liquid Capacity= -------gals. Privy: Distance from'nearest well-------------------------------------------------Distance from nearest bui)ding--.--------------------------------------- ElDistance to ri'earesf-lot line--------------------------------------------------- - - -- ----------- --------------------------------------- Remodeling and/or repairing {describe):__--- / - --t_ -------____..._...71---------r -------- - - ------ -- -- -------------------------------------------------------------- ----- _ --- - -------- -- ------- -- - - -- ------- -------------------------------------------------------------------------------------------7777!�------------------------- ------------------- - --- ------------------- ---------------------------- ------------------------1----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------- - I hereby certify that I h _5oya-pNqpared this application and that the work will be lane in accordance with San Joaquin County ordinances, State Jaws(.ffQ rules d regulations of the San Joaquin Local Health District. R1- ----- ----- (Signed)--------------------- .... ...S# ---------- ---- - ---(Owneranjior C, ----- --- -- -- - ------- ------ --------------------- - --- ----- ..... /or Contractor) By:-------------------- ------ --- - ----------- --- -----------------------(Title)------- -- - ---------------------------------------------- rev. reverse 'i �o (Plot plan, showing size olot, 6cafion of system in reld rionfio wells, buildings, etc., can be place n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED--B--y---__- -----------------------------------------------------r----------------- ----------- DATE I;---------------------------------•------------------- -- ------------ - REVIEWED BY - - - DATE---. -- BUILDING PERMIT ISSUED ------------------- -- ; ------------------- DATE__--- ----------------------------------------------- Alterations and/or recommendation's------------------------------------------ ............. ----------=--------------===---------------------------------------------------------------------- ---•--••------•---------------- -----------------------------------------------------------------------------------------------------------------I------- ------- -------------------------------••-------------------------- u -------------------------------------------------------- 11---------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------------ ----------- ------------------ FINAL INSPECTION ---------------11---------------------- ----------------------------------------------------------------------------------- BY- --------------- ------------- ------ ------ Date-- _1r71-------------- ------------------------------------------- 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 10-52 Revised W-2100