5587 - Laserfiche WebLink

Home Browse Search

I� APPLICATION FOR SANITATION PERMIT Permit No. ___✓�"`�-a __ (Complete in Duplicate) 9 Date Issued " Applica{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 with County Ordinance No. 549. ,I JOB ADDRESS AND LOCATION `�"---`---- � � ` ��-�----- ------------------------------------------ Owner's = ----------------- .. Owner's Name ----------------------------------------- _rZ-Tv--e-L)----------------------------------- ------- Phone_._.--_11------------------------------- Xdclress ------------------------ -�1,-- ��;Y -- ----- f Contractor's Name----------- I1----•--•-----------------------•---•-------------------------- -—----------------------- -•--•-------- Phone---_�I.---••------------------------ Installation will serve: Residence 91—A-partment House ❑ . Commercial ❑} Trailer Court ❑ Motel � Other E]Number of living units: __/___ Number of bedrooms __r Number of baths ___�. Lot size __________� L, -/ 2— - -------------------------- Water Supply: Public system ❑ Community system ❑'-Private �epth o Water Table __'_____ ft. "q Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes 0 No ❑ (iAotgr 711?� cam, TYPE OF INSTALLATION I;AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ) Septic nk: Distance from nearest well--- from foundation:--IP --_____-Mate ial:_ ��G �y '_--------- No. of'rcompartments_.__ __._ --------Size__3�C.9.��, -________Liquid depth_____I �O _.____Capacity_..__C--10 Q) s ; le from nearest we€i___Sir __.._.Distance from foun,dafion___.LP_r_.�'_Distance to nearest lot line_____ r.__. Dis os1 I Field: Number of lines-------•---� ---- ------Length of each liner-_-__--�----------':Width of trench.-JI-_-----z 41�-_--_------ Type of,filter material__-'_ __ v _.Depth of filter material___.__ 1 7__._-Total length--------- _______________ Seepage Pit: Distance to nearest well-----------------------Distance from-foundation___ ---------------Distance to neares'' lot line______._._..___.. ❑' Number of pits----------------------Lining material_-------------Yt'_.Sizei Diameter_-_______.___----------Depth-��-----------------------------_- Cesspool: D,stance from nearest well-----------------Distance from foundation._.----____ ------Lining material-------"- ---------- -------------- ❑; Size: Diameter----- -------------------------------Depth------------------------------#---------#--- .Liquid Capacity-.�iIl`-----------------------gals. Privy: ' e from nearest well__________________._____._______.___-_________Distan.ce from nearest building.___ i-_.________--_________________- Distanc ❑; Ie to nearest lot Eine----------------- -------------------------------------------------- ' Remodeling and/or repairing (describe):--'----------------------------------- -------------=-------------------- -- II , % IM: . ------------- -----------------------------•----•-•--------•--------------------- ---------------••------------------------• `----------------------------- ------------------------------ 1 # 'I -----------------------------------------------�I------------------- = I l 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 District. S ------------------------- ----------- rSi Signed) - ------•-------------------- ----------------(Owner,and/or Contractor) 'BTitle ' Ian, showing of-I°--------------•---• -•-� -------------------------------------------------'--------------------------- (Plot p g o+, location of system in relation to wells, buildings, etc., can be placed on reverse side). Y x `.41. it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- ---- -------------------------- -------•--------------------- DATE-- . �' REVIEWED BY-------------•------------------ ---------- DATE_ " 1 - -- ----- ='f&iM- ------- BUILDING PERMIT ISSUED--------------- -------------------------- DATE----------•--------------=IM Alterations and/or recommendations------------------------------------------------ ---------- --•-------•-------------------------------------------F ...�. - jr ---------------------II ---------- -- --- -------- ----- -•-------------------------------------------------------• - __-- -----------------------------------• ------- '----------- -- I, -- -I- FINAL INSPECTION 8 -_--_ J C� Date - / y - - I� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street. 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California k ES---9--2M ; Revised W-2100