Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Osy�� APPLICATION .FOR SANITATION PERMIT Permit No. .__ _ _ls - <br /> (Complete in Duplicate <br /> Data Issued ---� _____ <br /> 4Ap�s <br /> plica"ion is hereby made to the San Joaquin Local Health District fora permit to construct and instalf the work herein described. <br /> application is made in compliance with County Ordinance No. 49. <br /> JOB ADDRESS AND OCA I - ----- = <br /> Owner's Name. , ----- ------- <br /> Address <br /> Phone ' <br /> --------•----- --- --- --�- --------- rrt__ r!' � <br /> Address. Phone.--- <br /> Contractor's Name---------------- ------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:___ _ Number of bedrooms,,,9--- Number of baths _//___ Lot size d. _d_________________________ <br /> Water Supply: Public.sysfem<Community system [I_'Private ❑ Depth to Water TabI+ C It. <br /> F Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ NO�E�New Construction: Yes No E] ' E <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool'permit+ed if public sewer is available within 200 feet.) ' <br /> fpc Ta Distance from nearesi well------ Distance from foundation_-__._____________-Material_____________.____%__.-.-_-_-_.__.__,________ <br /> No. of compartments------- ------------------Size---•-----------•----------------Liquid depth--------------------------Capacity-•----- ----------_ <br /> 03 <br /> 3sal iel Distance from nearest well_ _______________Distance from foundation_------_.___.____._Distance to nearest lot line____.--..________Number of lines-----------------------------------Length of each line------+------------- -- Width of trench. d <br /> Type of filter material----------:---------------Depth of filter material........................Total length----------------._______---_____-____--._ ' <br /> m .. <br /> Xeepao, It: Distance to nearest well_ Ditance f om foutfdation �_f.___.Distance to nearest lot lineNumber of pits--- ----------------Lining material_ / I -.Size: iameter__�_ __...__..-.__Depfh____� '______________: Distance from nearest well________________Distance from foundation <br /> ---------- <br /> material--------------------------------- <br /> --_ <br /> Size:-Diameter ---------- ---Depth ----------------------- <br /> Privy: <br /> '- Liquid Capacity------------•---------------gals. 1 <br /> ❑ i , <br /> Privy: Distance from nearest well--______----------------------------------------Distance from nearest building__________._._______________----_-_____. <br /> ❑. �*- -Distance'to nearest lot line------- ----------------------------------- , F----------- - 3 s`` <br /> Remodeling and/o repairing (descr;be):__:----�------_F,� ------ ----V -.� -----__ _ __.._ �'``-~---•------•-- 3 <br /> ------ - <br /> -- <br /> / ----•------------- -------t•---•---------------•-_...-.-------•------------------------------------------•---------------------------------•-----------------------------.------------------- <br /> ------------ <br /> ------------------------------- <br /> I hereby certify/+hat I hav prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an s and re afiopt of the San Joaquin Local Health District. <br /> 4 Contract <br /> ------- ------- ---- -- <br /> r (Signed}------------•• ------------- -- --- -- ------ -=- -------%�: - ------, -_--------- � - caner and/on or) <br /> By:------------•----------------------------- ' ` ref ---- (T.i+lel ��•'-------- <br /> s <br /> ------ <br /> i (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be pla on� rse side]. i <br /> ! FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---------------- -----------------•-------------------------------------- DATE----- ---------------------------------------------------- <br /> REVIEWED BY--- --- BY---------------- <br /> DATE__ .��y(7 ---"-'---------- <br /> BUILDING PERMIT ISSUED DATE------------------------------- <br /> Alterationsand/or recommenda+ions:----------------------------------------------- -----------------------•-------------------------------------•--------------•-------=------------------------- <br /> { <br /> -------------------------------------------------- •----------•-----------------------------------------------------------------------•----------•--------------•------------------- <br /> ----------------------------------------------- --------------------------------- ---------------- -------­---- -------------- ----- ---------•--•------------ <br /> ---------- ----•-----------------------------------•------------------=---- -------------------------- ------------------------- ------------------------ <br /> ��12 <br /> FINALINSPECTION=BY:. — - ---------------------�------------•--- =----------- Date_.."- ----.-----------------------------------------------------------------•--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M : Revised W-2300 <br />