5997 - Laserfiche WebLink

Home Browse Search

0\* ��y APPLICATION FOR SANITATION PERMIT Perm+"No. --.. ------------- 411( --_99 � 11 (Complete in Duplicate) Date Issued -_ -`_J� lira+ion is hereby r A � - pp y 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. J08 ADDRESS AN LOCATION.-�-- - 7--D _ / 5 " � —� Owner's Name-------- -- � �� ------ ------ ------- one- ---- ------�'--C� Address �r -- Contractor's Name----------------------------- �� ------ 4 •-• ---------•------•- -------------------------------•-- Phone---•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Fourt ❑ Motel ❑ Other Number of living units: ___Number of bedrooms _;�_ Number of baths _- Lo ize _44-. L Water Supply: Public system ❑'ommunity system ❑ Private E❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:. and ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑ S ,vxI TYPE OF INSTALLATION AND SPECIFICATIONS: '6�Er� (No septic tank or cesspool permitted if public sewer is available within 200 fee ) Septic Tan Distance from nearest well-- _Distance from foundation_ • --_-----.Mater�aL-- Cr' No. of compartments---Z-- -- •� `i I . ------------- _--Sizea.- >mGiquid depth---4.5----------------Capacity--/Q _P- faro_ .I Dis osal Field: Distance from nearest well------------------Distance from foundation----_-_.---------.-.Distance to nearest lo} line- _-----.---_--_- i ` Number of lines----------------------- ------ ,-Length of each line------------------------------Width of trench-- ---------- ---� Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage ----_-_-----_---- --_-Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line F71 Number of pits----------------------Lining material----------------------.Size: Diameter------- ------Depth----- ---------------- Cesspool: Distance from nearest well---------_---__-Distance from foundation__-----__--.------.Lining material--------------------- . ❑ Size: Diameter-----1----------------------- ------Depth------------------------------------------------ --Liquid Capacity----------------------------------- --------gats. O Privy: Distance from nearest well------------------------ _-.---------Distance from nearest building ------------------ ' ❑ Distance,to nearest lot line-------------------------------- _ Remodeling and/or repairing (describe)-------------------- --------------------------------------------- #----- -------• •-------------------------•---------------- ' ----- •---- ----- - ----- ------ - - -- ---------------- --•-- --•--- - --- ----- I her certify th_a.f I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , S ate laws and �rles and :regulations of the San Joaquin Local Health District. (Signed)----- . Contractor) By:------------ -----------------------------... -(Title)----•---------------- - -- - - (Plot plan, showing size of lot, location of system in relation tY,-iljuildings, of , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __-_---•__-___----_- DATE- __--_-•_-..__ -------------•---------'•----------- h REVIEWED E I IS -- E ----- DATE �-r-------------------- ----- ----- BUILDING PERMIT ISSUED ... -------- ----------------------------------------------- DATE--------- Alterations 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-9-2M � Re0sed W-2100