8209 - Laserfiche WebLink

Home Browse Search

F� S/ ti 2� :• _ v �w �A•�• -�•�`-� � i,,� a ..� .� Permit No. -----��'�d__.(_p '' ' •f" '�'"~ APFLICATION FOR,...SANITATION PERMIT w li D i l (Compete n Duplicate) . Date issued f Applica*ion 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 with County Ordinance No. 5_ �. -------------------------------------------- � JOB ADDRESS AND LOCATION--------------- ---------------------------------------------- �z --------- Phone-------------------------------- - �._ ---- Owner's Name-------------------------------------- -------------------- -------------•--------------------•--- Address-----------•---------------•-----------------------------• -- -, �--� --------•-•------ Contractor's Name--------------------------------- -•--- Y' -----------------------------•------- ----------------• - Phone------------------------------- Installation ----- -•-----------•---------Installation will serve: Residence Apartment House [I Commercial E] Trailer Court ❑ Motel El Other ❑ f - ff � Number of living units: ____(-_ Number of bedrooms .- -. Number of baths _f_`_ Lot size __________---f'__--�_X-t_----- _ _ ________________ i Wafter Supply: Public system Community system ❑ Private ❑ Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ ` Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application.Made: Yes ❑ Noja New Construction: Yes,M_No Pit' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 ._ e -- ----------------Li Liquid depth--------------------- lj No. of compartments_._._._.. --Siz q k } Se ti .Tank: Distance from nearest well__,_______________Distance from foundation--------------------Material_------ Capacity_______._-_____---____- P y` Number or lines Length of each line ------ ---.-Width of trench ---------------------------- Dis❑oral`Field: Distance from nearest well_______________-Distance from foundation--------------- Distance to nearest loft line._______...-. f Type of filter material-------- ------------- -Depth of filter material_----------------- ----Total length---------------•---------------------•---- Seepage Pit: Distance to nearest well----- -------`_--------Distance from foundation__------------------Distance to nearest lot line_-_________----_ ❑ Number of pits.=_ =-:=- " Lining material-------------- ---- f0 c----------=---------------- Distance from foundation______ -------Linin material___.___.-: - -Size: Diameter----•--- ___--- - - .Depth --- --- Cesspool: Diameter nearest well:___"__ _- g } ------Li Liquid Capacity /-'o6-----.gals. bc'4---x------- -------Depth----------- „ q P Y 9 �(! romnearest well __._ Distance from nearest building-- _-_-____-____________--____- Privy: Distance` ----- ----------------------- ❑ Distance to nea ------------------------------------------------------------------- rest lot_line - - ------------ Remodeling and/or re'airin cle tribe ---------------------------------------------------•------------------------------=---_---•---•---- ---------------------------------------------- y --- --•----- y �. ► ---------------------------- '•-------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, Stat laws; and rules and regulations of the San Joaquin Local Health District. x ,� (Owner and/or Contractor (Signed)...' `` :__ --R -_---- ---------------- ------ - ------••----------- •-------------------------------------------- =--------------I------------------------ Tit le --------- ----------------------------------------------------- By: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------- ---------- DATE RATE � � REVIEWED BY------------------------------------- ------- -------- --------- ------------- - ---- :------•----�--•----. ------------ ----------•--- �-- ------------------------- BUILDING PERMIT ISSUED----•---------------- ---- ----------- - - ----------------•------------------- DATE---------------------------------------------------------- r Alterations and/or recommendations:__.------------------------ ••--•-•---•------•-•-•------•--- -----------------------------------�--l(y-�---------------------------------- -- - ------ �y... ...r— --------------------------- - - -- ---------- - ------ _---__-_--__ �. s� �� .^a._.-..---•----�'--�"�t �i..�-cam--- x. �l ` � 1 _ �'�'��r"''q,� G �i'�"•,� .'+�+�� 6°-'sit/ .,i'.�.t�u's�r'6'' r 1+! 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 Q� ES-9 145446 ATWOCD - A--