2268 - Laserfiche WebLink

Home Browse Search

Permit No.-A APPLICATION FOR SANITATION PERMIT '#(r: _ r (Complete in Duplicate) "b4afe Issued }' �__tSI�Z Application is hereby made to the San Joaquin Local Health District for ermit to onstru'#Und i tall th work erein described. This application is made in compliance with County Ordinance No. 549 i� - �JOB ADDRESS A LO TION = r f -- Owner's Name `' • k d - 'a --------- t--------------------------------------------- ------------------- ------------ Phone---------------- erJ f------------------------------------------------------------------------------------------------------------------------------- Contractor's Name----- r' Phone �s4, ----------------------- Installation will serve: esidence Er Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1_--- Number of bedrooms _ -_ Number of baths __�---- Lot size 14` --------------------- Water Supply: Public system ❑ Community system ❑ Private'Ey Depth to Water Table __ ___ ft. <71 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam��Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑Y No -New Construction: Yes io Nq M[ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material ______________"-- _____. �+ j F4 111Y No. of compartments Size -----------------Li Liquid de th---------------- --------Ca Capacity f q p p Y - Disposal Field: Distance from nearest well-----------------Distance from foundation__________________Distance to nearest lot line-__________-_-__ � Number of lines--------- -------------------------Length of each line-------- ---------------------Width of trench-------------------------------- Type of filter material_____________________ 1 _ ___Depth of filter material length____________________________ ____ to r - / ! See pa e Pit: hlumabereof nearest well---,.-/ 4_- material -K foundation__/��_ __.Distance to nearest lot line_____: 1 p )---------- g---- � -�� Size: Diameter_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__________________-______--_-__-____. ❑ Size: Diameter--------------------------------------Depth-------'--------------------------------------------Liquid Capacity----•----------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearestf ding---------------------------------- ❑ Distance to nearest lot line ---Aw -----------------�------ � Y Re, odelin and/or- repairin (describe)__________________ ____ -f__ r�-u- -•-------- ---- ' �/}} .._.._ --------------- - ----- ------- - s'{' --- ----- -- - r tif�'`{ = � � ------ -------------------------------------------- ----------- --------------------- I he e certify that I" ave prepared t is app i ion�and thathe wor will bedonein accordance with San Joaquin County ordinances, State I , and ruleula+ions of the San Joagui ocal Health District. (Signed)-------------- ------- -" ---- --- -- ---- -"--- --- ----- (Owner / - / r - -------------(O er and or Contractor —. _ ._.. BY:--- ------r' - ` -2 -J--- ----- -----(Title)---------------------------- . . . "' ' . (Plot plan, showing sl o`f lot, loc ion of e in relatio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-<�--------------------------- ------------- DATE_�'�' ------------------------------------------------ REVIEWED BY t'�•. DATE ------------------------------------------ ------------------------------------------- BUILDING PERMIT ISSUED ---------------- ------ DATE and/or recommendations:_______.______________________ _ --------------------------------•----------- 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 ES-4-2M 9-51 Revised W-2100