5889 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ...,� _.. (Complete in Duplicate) Date Issued ?,Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and ' stall the work herein described. This application is made in compliance with-County Ordinance No. 549. 3 " JOB ADDRESS AND LOCATION. - - ----- Owner's Owners e f - ---------- ---- - Phone Addres `�'°�' _ .. ---- - - -------��r �J �� c'� Ar��r �-P��r�,�� .._ r Contractor's Name-.- {_:-+ ".---------------------------------=-------------------------------- Phone Installation will `serve: 'Residence Apartouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ f, r [ / #Number of living units: ------ Number of bedrooms,._ Number of baths __d-___ Lot size " ___ _ ✓" "�?�T_______ Water Supply: Public system ❑ 'Community system'❑ Privaf�eV Depth to Wafer Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes 0 . o�NNew Construction: Yes No Llr TYPE OF INSTALLATION AND SPECIFICATIONS: '(No septic tankFor cesspool permitted if. public sewer is available within 200 feet.) eptic_ Ta Distance from nearest well_________________Distance from foundation--------------------Material______"-____-_______________"-.___________-__. No of compartments--------------------------Size------••------------------------Liquid depth-------------- -- -------.Capacity...---------- ------ Disposal,FFii Distance from nearest-well------------------Distance from foundation--------------------Distance to nearest lot line----------------- © 'Number of lines-------------___-------------------Length of each line------------------------------Width of french------------------------------------ / Type of filter material------------------------- of filter material-----------------------Total length-.-___-_-__--__-___________-_.____________ See age Pit: "'Dis+ante to nearest well -J ___.Distance f m fours�.ation__ -______Distance to nearest lot line - __�__ Number of pits_____ _____________Lining {aterial _ _ . .___ -a,Size: Diameter____Y__.__.________.Depth____ ��__---__-________ Cesspool: Distance from.nearest well-----------------Distance from foundation---------------------Lining material-------------------------------------- ❑ Size: Diameter------ I-------------------------p-- Depth-------------------------------------------- . �----Li uid Ca acity----------------------------gals. Privy- 4 Distance from nearest well _____________ .'---Distance from nearest building 'Distance to nearest lot'line.�:'-m------------ -- - ----- •---- ------- ---- ---------------------------------------------- Remodeling and/or repairing (describe):--. # ''�------X1--e � `"" .:.. = - -------------------------------- lop 7 ----- �--�- -�� .---`�------------------ ------------------------- ---------- -------------- --------- .----------------- I hereby ceify that I hav"repared this-application and that the work will be done in accordance with San Joaquin County ordinances, Sta s, a !1• es , d regulations,of-the San Joaquin Local Health District.' Si ned and/o YContractarl �__ ____Owner $Y• ---------------------------------------------------------- {Titlej �. (Plot plan, showing siz lot, loc tion of system in relation to wells, buildings, etc., can be PILWon reverse side). t FOR DEPARTMENT USE ONLY V APPLICATION ACCEPTED BY --------------••--------- ------ DATE ------ REVIEWED BY----------- -------------------- ------ _- DATE-----_v------•--------------- -------- BUILDING PERMIT ISSUED-------------------------------------------- _. ------------- DATE.. ----- -- ---- tions and/or recommend atio --------------------- -- - �. �` ------------- _._ _____________________________4__. _ ___ - ____.__ __ _ .__ _ ______-__ ._. ____._________ ____________ ___________.____ ______________________________________._____________.-•____._._______.-----------------_ ---.--------------------------------.----.!.-.TSS-. --..__-----_•_•--.•_----------. -. ---------------------_____________---________1______.__________________._.______.____-_--_-_----._-_._______._.._______._____________.'_______________________.__________________________ f ___.___-__-_ ________________________'_._...____._.-._____.___.._____.__._-_.__.._..__________-__.-_ . i FINAL INSPECTION-BY:_:----------= F — -- '=-------- �- Date........../_A�1.7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California r 1 E5-9---2M Revised W-2100_