9503 - Laserfiche WebLink

Home Browse Search

q d APPLICATION FOR SANITATION PERMIT Permit No. 5 {Complete in Duplicate} Date Issued 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. A3�r p p JOB ADDRE ND LOCATION--------�= /--- ----- ,--'`,t--'.....------ C '} (�E1 t (0111 Owner's N ,erne Z- - f- ------------ ! Phone Address •------• -------------•- -----------------------------------•----- --- ------ ------------------------------------------------•----------- Contractor's Name -------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other 0 , Number of living units: _ . Number of bedrooms --'Number of baths J___ Lot size _____ __________________ Water Supply: Public system I] Community system ❑ Private 2j-1Dpth to Water Table-615t. Character of soil to a depth of'3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe W/Hardpan ❑ Previous Application Made: Yes ❑ No E31"',New Construction: Yes [04o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool 4permitted�.if -bhc ewer�is-avail!able within 200 feet.) Septic Distance from1nearest w I Dzae Fom, foundat'o. _ f. � -----••--o- ifdh-._ � - _No. of ept _ ______ _ _ Capacity.fCTC ? f.-_(; ) _ = g from foundation__1_ _____.Distance to nearest lot lin __ __ f� - Dis Disposal Field: jf NuDismlAer ofol neseareist well-4; -- Dengfh`of'each line- p-__ r__.Width of trench__1Z�^____________________ E i .r Type of filter'material_____ ___-_- __Depth of filter matenaL__.-- --------- ota! lengths.?�_?_________.__..._______ Seepage Pit: Distance to'nearest well_/Q _---------Distance rom foundation__-- ___® ___.Distance; -_R to nearest cot lin�_p_ _________ [# ter Number of pits_-___�_____________Lining material_'_____________ __ +Suez Diameter__�_o� -____.Depth___ __..L--___-----______ I r f- Cesspool: Distance from nearest well-----------------Distance from foundation------------:_.-----Lining material------------------- --__.____________- ❑ Size: Diameter-I------:-----------------------------Depth--------------•-------~f ----------"'-------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------....Distance from, nearest building------________-______________-________-.- ❑ Distance to nearest lot�line---- '---- = ----- ---- ----------- --- --=------------- Remodeling and/or repairing (describe):--_!!'�7•__`----- --------------------------------------------------------- ----- '---------------------------------------7 --------------•------ - 1 f hereb certify that-I have prepared this application a ------ -----••---------- - -- y y and that the work will be done in accordance with San Joaquin County I ordinances,�St aws, and rules and reguletion'syofythe Sart Joaquin Loc ealth District. j . ; t" 1 ( g )---- r Contractor) Si ned (� .. �f-- - - -------- - ----- ---------�`W---''------_- _ Title)L By- ` ---- { )------------------------------------------------------- ------- (Plot plan, showing size of lot; location of system in x la ' n.to wells, buildings, C., can be placed on reverse side). r j FOR DEPARTMENT USE ONL(') APPLICATION ACCEPTED BY ------------ ----------- ------------------------------------------------------ DATI��---- -------------•--------------- --- REVIEWEDBY---------------- = ---- -- -------------------------------------'------------------------------------------ DATE--:Z, --------------------- BUILDING PERMIT ISSUED---------------------------------------------------- ------------------------------------------------ DATE------jpQ------------------------------------------------ Alferaf ions and/or recommendations:------------------------------------- •----------------- --------------------------------•--•----•------------------•--------------------•------------•-- i -----------------------------------•-----------------------•-------------------------------------- -------------- ------- --------- ------• -------------- ------ -------- --------------------•----------••-- -----------------------•---•--•----•----------------------------•-------------------------------------------• •-•-------------------------------------------- --------------------- --------------------------------------- FINAL INSPECTION BY:_ a ------------ ------ Date--- _. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Forth "C" Street Stockton, California Lotti, California Manteca, California Tracy, California ES-9-21x1 . Revises )-57 F.P.CO-