4246 - Laserfiche WebLink

Home Browse Search

e's APPLICATION POR $ANITATION PERMIT Permit No.(Complete in Duplicate) r,,. 7 Date Issuedati n is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-./O-?. --- -----------------------------z" -- ------ - ------------- +r7� Owner's Name------ A.�.�------- --------- Phone--.._2 -/r772--•--- Address-----IS7P219--- --------- --------------- Contractor's Name-------- --- -------------------------------------- Phone--�-------------- ---- Installation will serve: Residence'El Apartment House ❑ Commercial OZ Trailer Court ❑ Motel ❑ Other E]Number of living units: -------- Number of bedrooms ________ Number of baths a�__ Lot size _ ��- - th �, -'"'�--- --------- Water Supply: Public system Community system ❑ Private I] Depth to Water Table �A_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICAT€ONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-Ar___Distance from foundation---/Al---- Materrl__ ------------------------- No. _____ ___ _______..._. No, of com artments_-.__ Sizes41X$7f__X961L _i uid de th_____ p ��-------------- q I? ----?_---------Capacity---/02",0-1'? Disposal Field: Distance from nearest well 4_._-Distance from foundatio _______ ______..Distance to nearest lot line------------- Number of lines___________ __________________Length of each line_____ a._-.-__-_______.Width of trench-.-__ _ `------________.__.. O' r Type of filter material--- ___Depth o r mat is.__ g 1 Total length Q Seeps e Pit: Distance to nearest well-. _._�`v._____Distanc from to nd tion__ _�+♦� _�. Distance to nearest lot line__.s..______ Number of pits-----._'-_-_----__Lining materi _ �_.�_.Si iameter_.(1 --------.__..Deptn_____..___.-5-_�________ Cesspool: Distance from nearest well__________._____Dis nce from foundat' n------------ -------Lining material__________________________________- . ❑ Size: Diameter----- ------------ --- ---------------Dep h---------------------- ----------------------------Liquid Capacity---------------'`-----------gals. " - 1 Privy: Distance from nearest tivell________________________...________..._________Distance from nearest building-----_--------------�`--------.___.____. ❑ v Distance to nearest lot line-------- - ------------------------------- ----------------- -------------------------------------------------•-------------------- 1 Remodeling and/or repairing (describe):_.__- , - ............. ..,.`... __ ___ -. _4_ ------------------------------------------ .------- ----------------------------------------- .-___._______.______.__.._ _________________________...._-..-___________._...._-.._-.___..._..__--..___._______--_-._-_-__.__._____ T __ ___________________ _ ______ ________ ___ -_________________-___________________---____-_-____..._--_-_-_.-_-.----___-_--_-_-._-_-____________--_________-____--___...___________.______.______.._ I here6y.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. (Si ned)= (O er and/or Contractor) ----------------------- ----- -------- n By:---------------------------- -----!lam . = ----------------------------- (Plot ---------------------------(Plot plan, showing size of lot, location of system in rel;,on to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- ----'----------------I�---- ---------------------------------- DATE-------------- REVIEWED BY-------------------------------------------------------------- v U ---------------- -------- -------------------------------- ----- DATE---------- --- -- - --------------------- BUILDING PERMIT ISSUED--------------- ----------------------------•- ----------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------------------- ----- - - -----------•----------------------------------------•-••-----------••-----------------------------------•----------- --------------------------------------------------•------ ------------------------------- ---------------------------------------------------------------------------•-•---------••------------------------------------ FINAL INSPECTION BY------------------- - - ------ Date----------- - --------- - -------------- 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