10899 - Laserfiche WebLink

Home Browse Search

4dtl N APPLICATION FOR SANITATION PERMIT Permit No. %G2?_ ,!7 (Complete in Duplicate) s / i 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 w*k County Ordine tlo. 549. /f JOB ADDRESS AND LO TION____________ _Q__ _ t ( - --- --------------------------------------- Owner's Name----------------------•--- ---------._....- ��3�'— ---------------- •----------------------- ----- Phone--} -- ill° .�^ Address =CSL ' ------------•--•---- Contractor's Name ------- Phone Installation will serve: Residence g -Apartment House [JI, Commercial ❑ Trail r Court ❑ Moteell ❑ Other ❑ Number of living units: umber of bedrooms __umber of baths - Lot size __-_-__747----If �_-- ___------________________ Water Supply: Public system V�_Community system ❑ !kJPrivate [❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E]" Sandy Loam El Clay Loam El Clay El - Adobe�Hardpan C]Previous Application Made: Yes E] No �1ew Construction: Yes,16,,,No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if Apbblidd seweris available within 200 feet.)Septi Tank: Distance from nearest wel!__ ./Distan e from ------------ fon attion--- Q , ____.Material�_____._-_____C___a____a_c__ No. of compartments- _� -__--------Sieqwd depth-__- - -----------Li _ p v DiSP04 Field: Distance from nearest well-- dDist3nce-from foundati n--- ________ Distance to nearest lot lin ---------------- 0 ______________ /" X11 / Number of lines______ ____ ________Length of each line____ __.�:_.__x _.__.Width of trench_ . ------------------ 4 Type of filter material_ _ __ _�sf____ _Depth of filter material___._ ��_____-Total length______ Q_ _______________________ r — �il! { _ s -, See a Pit: Distance to nearest well__ u ,.r___Distance from foundations____.Distance to nearest lot line---______-__-_._ p g dp. ,a '° p t Dumber of its_____ ______________Linin materiaL_��. .......Size: Diameter____ __ -__._-_____De th_--_�_.-_-_________._____ R , �I ------------ Cesspool: Distance from nearest well_________________Distance from foundation____________..___.Lining material_______--__-_--____-- ❑ Size: Diameter-------------------------.--- --------Der?th-------------------------- ----------------- --Liquid Capacity---------------------------gals;. Privy: Distance from nearest well_____________________I--1_-_.______-_________--___Distance from nearest building---------- -------------______-__- ❑ Distance to nearest lot line--- ----------------�P-`----•------------------------------------------ ------------------------- Remodeling and/or repairing (d cvibe)=--------------- `!1= --------------------•----------------•---------------------•---------•----•-------------- ---------------------i----------------------------------- - ----- -- - -- ------ -- ---_---------------------- ---------------------------------------------------------------------------------- ------ IIIlil�: ----------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application aid that the work will be done in accordance with San Joaquin County ordinance laws, and rules nd regulations of the Sa'r �yuin Local Health District. (Sign � ' -q ---Rel ;' �-- Contractor) - G 1 -- By:------------------------------- ---•--------------------------- -------- --Lo�4w -- s,._`-"''------ --- {Tit lel (Plot plan, showing size of lot, location of system in r ells, building , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �F r APPLICATION ACCEPTED BY- - .'_lt -------------- ---------------------------------------- DATE------- l b ` -------- REVIEWEDBY-------------- -------------- Ir -- -------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or'recommendations:__________ __ _________ ---- - ----- ----------------- --------- ----------------- r1 ------ - '----------�'---- =1 ------------------------------------------------- --•------------------------------- =----- ------------------------------------------------------------------------•-----•----------------------------------------- ----------- - - --------------------------------- ---------------------------------------- - - .- --------------------------------------------------- ----------------------------------------------------- ------------ ------- II FINAL INSPECTION BY:--- - -------- :----------------- Date------ ----- --- -S -------------------------------------- SAN JOAQUIN iLOCAL 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 , Revised1.57 F.P.CO. I' _