4922 - Laserfiche WebLink

Home Browse Search

`, kt APPLICATION .FOR SANITATION PERMIT Permit No. .:_. ------ •.. t r- (Complefe.in Duplicate) Date Issued ---/a-A./s.f Application is hereby made to the San Joaquin Local Health-Distfict-for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 0 L�' r ` JOB ADDRESS AND LO ATION ' - ---------�- ------- ��' ------��e 'Xr- ------------------ Owner's Name------------ -- ---- -- -. Phone-------------- --------------- Address-----------•-----------------------------------------------------------------------------------------------------•------------- ---•--- --------------------------------------_ Contractor's' Name----------------- -------^---------------------------------------------------------------------------------.-. Phone------------------------------------ Installation ---------- -------Installation will serve: Residence Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1__.Number of bedrooms ---- —IQumber of baths ._[----- Lot size ---- -- -_--X--_p_ . ® Water Supply: Public system E�- Co munity`systbfn-❑""Private-❑- Depth to'Wates Table.------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loarri❑ Clay ❑ Adobe an ❑ '* Previous Application Made: Yes ❑ NoNew Construction: Yes4u_lA&_] TYPE OF INSTALLATION AND SPECIFICATIONS: - r (No septic tank or cesspool-permitted if fli public sewer is available within 200 feet.) i ` Septic Tank: w Distance from nearest well_- �Dist6fice'frofii�foundation._/__ _ Material-----_aluk _-:. No- of compartments-_____. .- Size___ x_ K_,rj.._.___Liquid depth.------ --------Capacity__.SP�Va___ACK Disposal Field: Distance from nearest w ]__ALQ_'1"Distance from foundation- Distance to nearest lot line______________ _ Number of lines------ __. Length of each line------ Width of trench. _*4_ - ----------- filter .--__- W Type of filter material_ _ [ th of filter material-.- �..._ _.__Total length_______ __ . _-_.____.__ r i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------.._-_.Distance to nearest lot line------__-_--_-_._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance fi-cm nearest well-----------------Distance from foundation.------------------.Lining material-------------------------------------- ❑ Size: Diameter-------------------------------------Depth- _ ,-------------------------------------''Liquid Capacity- -------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_-------__.-._-___--__.____.___._-..._ ❑ Distance to nearest lot line------------------------------------- =- --------------------- Qs Remodeling and/or repairing (describe):------ -------------� ------------- , ------------•----------------- -----------------------------------------------------------------•-----•-- ----------------------------------------------------------------------------...---------------• --•-----•--------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health-Disfricf. (Signed)--)4---�-�r:'----ems-- -- Y--- �----------------------------------------------------------------------------------{Owner and/or Contractor) }} By:-------------------------------------- --------} ---------------------------------------------------------------------------------(Title} (Plot plan, showing siie of lot, location of system in-relafion to wells, buildings, etc., can be placed on reverse side). " J FOR DEPARTMENT USE ONLY ' APPLICATION-ACCEPTED BY--------- - -- -------------------------Y---.----------------- --------------------------------- DATE-----------�----- REVIEWED ---------------------- ------- ---------------------------------------------- DATE---------------- -------- BUILDING PERMIT ISSUED---------------------------------------- --------------- DATE- ----------------- -------------- Alterations and/or recommendations--------------- --- -- - ----------------------------------------------------------------------------------•-•--•--------•----------------- Y-, 1 ---------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------•------••------------------•------------------- x ------------------------ --------------------------- ------ --- -- --- --------------�---------------------------- ------------- ---------------------------- . FINAL INSPECTION BY:.....`.. ;- i-- - ---- = - 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 3 ES--9-2M Revised W-2100 r