19283 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --__- -- -= ---.--- -_- APPLICATION FOR SANITATION PERMIT Permit No. -- -- - —- --'r-.----------�`-------------- ;-- (Complete in Duplicate) bate Issued ___ �l /�. ............._---------------------------------•---------- This Permit Expires 1 Year From Date issued ___!-,/—t 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 iP cgfnplianc, with County Ordinance No. 549. x. l-6 ° _. _ � JOS ADDRESS A DLO ATION______ _ _ co t ___ 6 Owner's Name 1 --k�---- do Phone------------------------------------ Address Address 2 ? 1�ca. n11/JQ ---------------------- Contractor's Name------- --------------- � x Installation will serve: Residence [Apartment House ❑ ;'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms-.-3- Number of-baths __Z_ Lot size -------- ---.___-________---____-_ K Water Supply: Public system [I Community system ❑ Private [ epth to Water Table__ ft. Character of soil to a depth 'of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe E4,14arclpan ❑ PreviousApplication Made: �ilf yes,date--------------------] Nom New Con uctiarn:eYes ❑ No-9-"FHANA: Yes 2�- rya ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,., (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance .from nearest wel1__,5-0,!_"}Distance from foundation-_/.C1- ____=___.Material-,CO-4811I-C __--_. No. of compartments----r`5----------------Size---S -,� _;V-;Vdepth-------- -- -_.-------Capacity__ -�_. x Dis os Field: Distance from nearest well-- ---..-Distance from foundation__ -/_P.. Distance to nearest lot line��----- Number of lines.._...._ _ Length of each line----_-,f`_'. -_ _T..Width of trench.._o�_._`,�__ ----- e of filter material-_-- th of filter material----__ ---- Type e<�.-� ��. .Total length-�/�JrJ---=------------------------ � I Q t7 f / See a Pit: Distance to nearest well_- ._._Distance front fo ndation____ (1_____.__.Distance to nearest lot line_ - 1 � - Number of pits--..__ -------Lining material----_ ......Size: Cesspool: Distance from nearest well------------------Distance from'foundation----------------_c-.Lining material--.-----.__--__------.-_-_______--v` ❑ - _- -- ------.De th---------------------------- -- ---------------- - U uid Capacity..--------------------------gals. �.Size: Diameter_____________ p q Privy: Distance from nearest well--- t------------------------------------------Distance from nearest building.------------------------------------------- El ----------------------------- -----.❑ Distance.to nearest lot line---- ---------- ------------------------------------------------------- -------------------------------------------------•------------------- Remodeling and/or repairing (describe)------------------------------------ ------... - ---•------------------------------ (' ` ---------------------------------------------------------- ----------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . I (Signed) f�------------------- - ___-:��.--.-------------------- (Owner and/or Contractor) �+ By:....------------ - ------ - --•----------- ------------------------------------------------------------------(Title)------le_� -- ` (Plot plan, showin a of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Y APPLICATION ACCEPTED BY- --- ------ -------- -- -- ------------------------------------------ DATE------ ------;71 't REVIEWEDBY --------------------- ------- --------------- ---------- --------------------------- y , DATE -----------�--�x-----,-c-=-�---------------------------------------- BUILDING --c-----_-�-----s----�---_-----f--i-L--1-`--1- --r-- -- bPTISSUED � ._ DATE. � - r Altertons c : �- •. ---- .Ind/or orrecomm n � - f' " � -----•-------•----- -- ------ L------- ----- ----�2 , 7, ---------------------------- ----- ------------------ ------ ------- ------- --------- ------------ ------ - -- --------------------------------------- --------------•---------------------------- ---------------- ----------------------------- FINAL INSPECTION BY:_ _ ------------------------ Date....................... .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelion Ave. 300 West Oak Streat.,, �. 124 Sycamore Street 205 West 9th Street Stockton,California :Lodi,California ' Manteca;California Tracy,California T