7689 - Laserfiche WebLink

Home Browse Search

�S {6� � z APPLICATION FOR SANITATION PERMIT 7 jetrmit No. =! •_____......F... ' (Complete in Duplicate) Date Issued --__ Applica4,ion 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 LOCA N ----Ig !it",,".�1L.- }� _J Owner's Name------- rE� --- -------------- -------------------------- -------- Phone------------------------------------ Address---------- Q` --------- ---------------------------------------...------------------------------..-. ------------ l Contractor's Name------ ! !---- �a Phone --•� Installation will serve: Residence Ul.,Apartment House ElCommercial E] Trailer Court L] Motel ❑ Other ❑ i Number of Eiving units: _ _._ Number of bedrooms _. ---Aluml?er of baths _ Lot size ______ _G?� .� - Water Supply: Public system QL Community system ❑ Private ❑ Depth to Water Table i�a ft. Character of soil to a depth of 3 fee+.' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q3�, Hardpan ❑ Previous Application Made: Yes ❑ No 1 a—NewConstruction: Yes, No ❑ Q i F - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n .r Septic Tank: Distance from nearest well-_.&_6T.i*istance from foundation----7.0__t----Mat r,al__._( No. of compartments...._,:----.- Size-- -- - -- ----Liquid depth._--:-- -4j...___..._-Capacity--•-��d�------ Disposal Field: Distance from nearest well...Nistance from foundation----�04------.Distance to nearest lot line_______. r Number of lines__________ __ __ Length of each line--------- ��`_:F_-�Nidth of trench_._._, -__../------------ Type of filter material___ ¢�------9RtDepth of filter material------- ._ _----__.Total length------- .�. __________________ Seepage Pit: Distance to nearest well___ �Bistance fro foundation......1;-41 -.Distance to nearest lot line-----<- Number ine-- <Number of ---------------Lining material_ e: Diameter------- -4'--.Depth_-----r��r,r ______________ Cesspool: Distance from 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--------:--------- ---------- -------------------------------------------------------------------•-------------------------------------------- Remodelingand/or repairing (describe}--------------------------=----------- ----------------------------------•-•----------------•-••---------I.......-..-------------------------------- ------------------------------------------- .... -------•----------- -----------•------------------------------------------------------------------------------------------------------------ --I----------- i 1 T ________________________________________________________________________________________________________________________________________________________________________________________ .� I hereby certify tha+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s and rules and regulations of the San Joaquin Local Health District. (Signed)------- ---- - - - -----1�--- --------------------------- (Owner and/or Contractor) �Y= = ---------------=----------(Title)------ •------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). b FOR DEPARTMENT USE ONLY APPLI�rrl N ACCEPTED BY---. .--- --- - ----`--- ---------------------- ----------------------------- DATE-------------------------------------------------- REVIEY-------- --- --=--- DATE � �--------•---••----------------------- BUILDINGPERMIT ISSUED-------------------------------- ------ ----------------------------- ----------------- DATE------ ----- -----�---------.-...- Alterations and/or recommendations:----------------- ____ _ __ _________________._----- -------------------•--------------------- --- - ---- -------------------- -----•--------------------------------•------------------------------------•-•-------- ---------------------- -------- -------------------- ----- ------- -------------------- ---------------- ----------------------------------- --------------------- ------------ FINAL INSPECTION BY:. > = Date- Z- — `"�-- ---- 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-4-2M 145446 A7W09U 12.54 -