2625 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. d4_-S _- (Complete in Duplicate) Q Date Issued ____�,I_. - �-- , 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 in compliance with County Ordinance No. 549. ,rr ;; - - �u" ' ----------------------------------- JOB ADDRESS AND LOCATiON____ ' "� _ ________ _�t_ _______ Owner's Name------------------------------------------------ -- --------------------------------------------- Phone---07n..7 --- -- --- ------------- ! c - f* --Address -7 'If� 7;-Z�s 7T�I-�- ------ Phone---9----5;_ _Q-------- Contractor's Name Installation will serve: Residence X' Apartment House ❑ Commercial E] Trailer Court E] Motel E] Other E]Number of livi __ng units: ___ Number of bedrooms Number of baths -_C____ Lot size __.5_Q_______�Z---------44?Q________-_ Water Supply: Public system ❑ Community system '❑ FrivafeV Depth to Water Table ______ ft. Character of soil to a depth of feVi Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jK Hardpan ❑ Previous Application Made: YesM No4W New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.] W ptic Ta fc: , Distance from nearest well_________________Distance from foundation--------------------Material___________________-______-__________________- t No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--------------------- T- I '`I Di s osal Field: Distance from nearest we11�4__,Q__-_.Distance from founda,�ion__ Q ____.Distance to nearest lot line_____-___- j 1 Number of lines____________ ______-__- _ Length of each line-_ -_-0-__-_-__ _F' Width of trench-00_ Type of filter material._.---t1-� ---Depth of filter material-------- --_,_.___Total length-------- ------------------------ See"gE Pit: Distance to nearest well----------------------Distance from foundation--------_-----------Distance to nearest lot line____----____----_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth--------------------------------- �` Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. Privy.: Distance from nearest well-------------------------------------------------Distance from nearest building______________________________ ❑ Distance to nearest lot line-------------------------------------------------------------------•---------------------------------•---------------------------------------- RemodelingCand/or repairing (describe)=------- ------------------------------ ------------------------------------------------------•----------.--------------•----------------•------•---------•-- i�Q/I.lc.6l�fir•• 1�,6 cs 1.,:=------ '_(rt�ta/_.-' -'- _.. I�F?fia.f RiY�.! .,_i.-�E�•""`-'-`---`-�1�'---�='�-n-4-fi•_..--------••--•-------•------- r - I ------------------------------------------------------•----•-•------------•••---••-------•---•---------------- F I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+ate aws, andules and regulations of the San Joaquin Local Health District. t i (Signed]..r ... -�. t ------ ---74--� & - I�=Contractor) By•... ...... .... �`'"- ----- —----'-------- ---------------------------------------- Title-- st _I__ ._>' _4_.f - (Plot pla , showi size of lot, location of system it relati�Wfo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE 0PLY 1 APPLICATION ACCEPTED BY---- '� t �"�-�'• DATE r �---�P--------- REVIEWEDBY------------ ------------------ ------------------------------------------ ------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------ - ---•--------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:-- --------------------------------------- ----------------------------- --•---------------------------------------•-----•-•----------------------------------- i ---------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------•- --•-------------- ! ------------------------------------------------------------------I---------------------------------------------------------------------------------------------------------------------------------•--------------------- -------------------------------------------------------------------------------------- -----------------------------•-------------------------------------------------------------------------------------------------- - -------------------------------------------------------- ----------------------------------------- --------- --------------- ------------------------- --------- !� ------------- --------------------- FINAL INSPECTION BY: Date i° - - --------- ------------------------------------------------- 4 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 E5---9-2M 8.51 Revised W-2100