5120 - Laserfiche WebLink

Home Browse Search

i APPLICATION FOR SANITATION PERMIT Permit No.�..1_a--v (Complete in Duplicate) .. . Date Issued Applica4ion 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 Ordinanc No. 549. JOB ADDRESS AND LOCATION------ -- �.__ 11I Owner's Name----------------••-•---•--------- 1 + � f i[-1: - -/�GE O- ?5. Address-•------------------------------------------ . Contractor's Name-----•------------•----------------------- ---- -- -- --------------------- Phon Installation will serve: Residence 1K Apartment House ❑_ Commercial ❑ Trailer Court ❑ Motel [ Other ❑ Number of living units: '_ Nui�n ber of bedrooms --/ Number of baths ._-*Lot size _--_-- _ -�-------------- Water Supply: Public systemA Community system E] Private E] Depth to Water Table -- --aft. 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 ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S • T Distance from nearest well-----------------Distance from foundation--------------------Material_----_--_--___--__------ f—'t No. of compartments-------------------------Size---------------------------------Liquid depth------------ Capacity----------••---------- e / s osal Field: Distance from nears - -- D it WE from foundation-- Distance to nearest lot line_ �• Number of lines___.: ___-_-_ � --'Length of each line--- -_--� �r Width of trench.-_- T e of filter material--��_.- _ _ Depth of filter material- --------- g y. ' : Total length IS - ------------ See age Pit: Distance to near es weII Q ____-_-Distanc f m f , ndation-AZ-------Distance to nearestto Number of pits---- ._- Lining material Size: Diameter__' 1 Depth____X�_�_------__. Cesspool: Distance from nearest well----------------- from oundation--------------------Lining material--.---__--------------- ------------- ❑ Size: Diameter----------------------- ---- Depth----------------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------- - , --_----'__---_---.-Distance from nearest building__- ----------------------------.-_.-____. ❑ Distance to nearest'lot:line ---------.-_---------------------------•---=----------='---- ------------------------------7! Remodeling and/or repairing (describe) ---------------------------------- :-----------------•------------=---------1 -----------•----------------------•-------------------- i.. 14• i -------.............-------------------------------------------------------------------------------------------------------------------.--------------------------------------------------------------------------------------- --------------------- ------ ------------------------ { !•hereby certi th t I haveprepare is�application and that the work wi l be done in accordance with San Joaquin County ordinances, State , and rul ' and reg ations� San Joaquin Local alth District. r � (Signed)---------------- ------ -nL•------ --- -- --- - - ------ ---- Contractor) By:-------------------------------------------------- ----------------- -- --------------(Titie)- $ ��r��?44'----------- (Plot plan, showing size of lot, location of system n elation to wells, build in etc., can be placed on reverse side). - t FOR-DEP..ART.MENT USE.-ONLY ' APPLICATION ACCEPTED BY - -- ------------------------- -- ----- ,f DATE-. �3 `�� -r-`--------------------- REVIEWED BY - --------------- ----------------- --------- --- DATE------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------- =------- DATE_4 ' Alterations and/or recommendatiops: ---------- -----------------------------------------------11----------------------------"_------------------------------ -------------------------- ----- •-------- ---- �/ FINAL WSPECTION BY:. --' ---' ='----------- -- •---. Date: --.---� ------SCJ---------- 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfraet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100