2679 - Laserfiche WebLink

Home Browse Search

�` 7 - APPLICATION FOR SANITATION PERMIT Permit No --__... (Complete in Duplicate) Date Issued ____:_ -" - /d- k 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. JOB ADDRESS AND LOCATION------ -- -------- --------------------- ---- Owner's Name---------- ..--- r�3' i -�-- -� ` .�_r---------------------- Phone------------------ ------ Address--------------- -----rl -------F� f � '-` -i� �Il!------------1- ------------------------------------------------------------------------------------------ + Contractor's Name----------------------------------- ------------------------------------- ------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ® Trailer Court ❑ Motel ❑ Other ❑- � r II Number of living units: _14 `dumber of bedrooms _V�_'%umber of baths __/____ Lot size _ �Q____x_�� _-.-_______ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. L Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe ® Hardpans[]\ Previous Application Made: Yes ❑ No © New Construction: Yes IN No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer i available within 200 feet.) Septic Tank: Distance from nearest weh__w!_ -_�~`Distance from found -_ _ ation__ _ Material_C :_ a z '-----------�,--- No, of compartments---------!--------_-__--Size--- X_3__X__�--___-Liquid depth_____ ----------------- Capacity.. Disposal Field: Distance from nearest well_X--Pn_+__.Distance from foundation---/4------------Distance to nearest lot line-------- _. I © Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------. Type of filter material-------------------------Depth of filter material_______________---.---Total length__--_-______________---___ # Seepage Pit:, Distance to nearest well_____________________Distance from foundation------------.-------Distance to nearest lot line___________-_____ ElNumber of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------.------------------------ Cesspool: Distance from nearest well-________________Distance from foundation______-____-_____.Lining material_____-__-_________-_______________- Size: Diameter------------------------- ----------IJeptl-----------------------------------------------------Liquid Capacity---------- -----------------gals. Privy: Distance from nearest well________________________---_---_----------------Distance from nearest building--------------___.___________---•_---_--_- ❑ Distance to nearest lot line----------------------------------------------------------------------•----------------------------------------------------------------------- e_ s `-- -----/Q.__ma_<_ yi_-,n_rc-mom .r' ------ 7 a-`--• � � �`� }' -----•----------------------- -------------•-------------------------------------------------------------------------------------I------------------------I----------------------------------------••---------- `I hereby certify that 1 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 District. (Signed)------------ - 4---------------------------------------------------------------------------------------(Owner and/or Contractor) By:---------------- - -------- -- ---- --------------------------------------------------------------------(Title} t� (Plot plan, showin size of lot,.location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR EPART ENT Uly ONLY r APPLICATION ACCEPTED SY t -- DATE --�,- - ---5_-_Z,------------- REVIEWEDBY-------------------------------------------------------------------------------------------7---------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------- Alterationsand/or recommendations-------- -------------------------------------- ------------------------- -------------------------------------------------------------= ----------------------------------------------•-----------•--------------------------------------------------------------------------------------------------I---------------------------- ____________________________________________ _ _ __ k FINALINSPECTION 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 e-51 Revised W-2100 rte-