20179 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ©_� .... -------- -------- -------------- ------ --------- ---r .(Complete in Duplicate) _ _--_--___----..-.-._-i__:. -- ° This Permit Ex ires 1 Year From Date Issued Date Issued ---------------- Application is hereby made to.the-San Joaquin Local Health District for e. permit to construct and install the work herein described. fapplication is made in compliance with County Ordinance No. 49. `- 0 '�- z�U-Ci This3'.,: £. H wNf ' JOB ADDRESS AND -L CATION__�:-��r�e -a1% �,v> _----------------------- "Name ---��--- `) ` Owner's"Name----- v`' - ._ Phone -----------•---=----••---- - Address------03.---- 1+----- =--------------------------- ------------------------------------------------------ ------------------------------------- i Phone s Name_-.- h- .�-=+x -- `-- 0------�",�=`-------;� ------ •--- P 9 Installation will serve: {Residence [�] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 # Number of living units: __�____ umber of bedrooms __3--- Number of baths r__ Lot size ------ ------------------------ N __. Water Supply: Public:system ❑ Community system ❑ Private eDepth to Water Table -------- ft. Character of soil to a depth of 3 feet:'}Sana-❑ Gravel 0 Sandy Loam kClay Loan; ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------- No ❑ New Construction: Yes ❑ No-❑ FHA/VA: Yes ❑ No ❑ TYPE.OF INSTALLATION AND SPECIFICATION5: (No septic tank or cesspool per miffed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---------------!Distance from foundation-------------------Material----------------------------------------._._____- ❑ No. of compartments-------- ---------!Size---------------•--------------..Liquid depth--------------------------Capacity----------------------- 'ne 1-.Field: Distance from nearest well:.:v7P__f___ Distance from foundation_____la_�__--- Distance to nearest lot line____----�...... �- Number of lines____-_____�._.._ .-_ __.__'Length of each line_____ f ---- Width of trench----�-- --------- ------------ 3d _.. Type of filter mafierial___. _ ` :__._.-_,Depth of falter material__.�_1-..'_____..Total length---------------------------------------- /4A.. See pa Pit: Distance to nearest well----- p_Q--_- Distance from foundation____./_0_1______.Distan e to nearest lot line___-5... - Number of pits-.-... �--------_Lining material_____cS.&------Size: Diameter-------3_.7.._.___..Dept h...ZX_. ------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-- ---------___._______.__________._. I ❑ Size: Diameter-------------------------- -----------Depth_---------------- ----------- -- ------------------Liquid Capacity--------------------------..gals. Q 1 _____�'- Distance from nearest building Privy: _ :. _ Distance from nearest well--------------------- ---- ------- - - g---------------------------------------- ❑ Distance to nearest lot line-- --- ---------------------- ----------------------------------------------------------------------------------------------------------- F .. -------_------------------- Remodeling and/or repairing (describe):-- _----- -- --------------�- ---- ----------------L--------------------------------------------------•------------------ ! --------------------------------------- >y # ---------------- ---------- --------------------------------------------------------= } . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Caunty ordinances, State laws, and rules and;regulations of the Sen Jaaquin Local Health District. } Q� I t � (signed) e ' ------------------ ----------------------------------- and/or Contractor) BY F {Title) (Plot plan, showing size of.lot, location of system in relation,to wells, buildi gcan be placed on reverse side). f ' I ?FOR-DEPARTMENT USE ONLY P' APPLICATIONACCEPTED BY-- --- -------------------------------=-------------------------- DATE__A-_ �_ --------------------------------- REVIEWEDBY----------------------------------------------- -------------------------- -------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------:r---------------------------------- ----------------------------- ----------------- DATE------------------------------------------------------------- Alterations -__ � ---------•------------------------------- + i ---------------------------------------------- ------------------------------- -----„---------------------------------v-•-- ------------------: ----------- ... �.- ,. sem- . -----•------•--------------------•----------'-----•-'-•---•---r--•---------- ---------------------- -------------------------------------------- FINAL INSPECTION BY:--.- - - ------------------ Date-.�-" •- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.kazetton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tra[yr California ES 9 REVISED B-59 3M 3-'63 F.P.CD.