9094 - Laserfiche WebLink

Home Browse Search

a 1'e , " 'r^� . a. q O APPLICATION FOR-SANITATION PERMIT " j Permit No. .......-G / (Com`plet"in"Duplicatis} —--- �- Date Issued --- - Thi3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. IIsapplication is made in compliance with County Ordinance No. 544. , r JOB ADDRESS AND LOCATION-:_-___°-_ " 4� Owner's Name. ----- -- �v S - - - Address / �- w��t� 1�� y - -------------------- Phone- --- --•-------- --- = -- -- - L_ -.: _ : --------- Contractor's Name- -- i 2 , ��4 Installation will serve: Residence , Apartment House Phone_. • $ y- ❑ Commercial [) Trailer Court ❑ MOW Number of living units: .,_- Number of bedrooms 1. Number of baths _,j Other ❑ Water Supply: Public's stem Lot size Y ❑ Commun'it s stem /S-� Y Y ❑ "Private J Depth to Wafer Table! ft. Character of soil to a depth of 3 feet: Sand } Gravel ❑ Sandy Loam ❑" Clay Loam ❑ Clay [] Adob -�" Previous Application Made: Yes No d Hardpan ❑ # ❑ i New Co'Construction: Yes ❑ Nab FHA/VA: Yes F No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank or`cesspool pern;itted 'if public sewer is available within 200 feet.) Septic Tank. Distance from nearest ( well .,___ Distance from foundation Its = ±----M -------_-------- ------oopra Size pas� eI ------------------- Liquid depth------------- r Capacity -VD s Distance from nearest well _ _- --_.Distance from fo �} ` uncJation_./------_ 0 Number of Imes_..._ ` _ ___ .--Len th of each line._-__._ -----Distance to nearest lat line.._._____--------- Type _ Width of trench.. Type of fi)fer•material _i / __ g r - -- /�__ --_ -- -Depth of filter material-__ /` "� {{ -- ---"--Total length-------- 6'_--------------------------- EI -- Seepage Pit: Distance to nearestfwell__ _______ _____ _pistence from foundation------- ............. � I ❑ Number,of pits------ ------------- Distance to nearest lot line.-.__._________-_ -•-- Cesspool: Distance from nearest.well.-- .._-.-_--Distance from foundation...-...__ -- r Depth.------------------------- --------------------------- ---_: - f. Size: Diamete _____________ ____ I- -__..Lining material.-_.. ❑ Size: Diameter --------- -- - --Depth--------------------- .__` -- Priv .=. , .. - =.Liquid Capacity.. . gals. Y: Distance 'from nearest well. . ."` '^" �'""= f .�.-T ti'a _.�,r....Y -_...��. ._..--."...ter ---- Distance from �nearesf buildin '" �; ❑ Distance to nearesfilot line.- -- --- g----------- - ------- 1 ------------- ' Remodeling and/or repairing (describe'_ ____________--_-_._--_ _ > ' " ---- -------- - - �- w_,"--------------------------- ------------ -------------------------•-----•-- # -----.---r_._ -- --------------------------ti _ l = r=_: �— = -------- ---- --------------------•---------- pp = --------- .1 -------------------------------------------------- --------- 1 hereb certifythat I have prepared this application an4f9at the-work will be done;in accordance with San Joaquin County ordinances, St Fe laws, and �.ti1Fts and regulations of'the San Joaquin F,LocaloHeal h District. . (Signed) � '� - -- f , ------------------------------ •---•------------:-- J (Owner and/or Carttractor} ( p } �..:.._ � - --- -------------- -- - Title_-`------ -- - ----- - -- of Ian, showing size of,�lot location iof system in.relatio to:wells, buildings, etc., can be placed on reverse side). _ U. . FOR DEPARTMENT USE ONLY -------------- ire APPLICATION ACCEPTED . ___ :._- - ------------------------: -__.._.__.__ 3 REVIEWED BY -- �- _. _ -- ----- DATE _L. .,.5�-.7.......... - --------------- ------ -- ``_. '""" c„ _ --- - ----- ATE:"._-. . ------- BUILDING PERMIT ISSUED_=...... _ ,g --------_ ` " ____ --- -------- DATE - ndations:___ — " ter tions and/or Leto m - ---- --- •. -- --•-- -------------------- ------------------------ ------------ = --. -- - • ------- -c r .................................. .-_..__._...___..._-..-____.__..-._.._.....-_.-_ --------- ----------------- ---------------------------- ----------------------------------------------- FINAL INSPECTION Date= e� -------- SAN JOAQUIN LOCAL HEALTH DIS ; TRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2ivf Revises 1•57 F•P.CO.