6231 - Laserfiche WebLink

Home Browse Search

Permit No. __G.�`'---------- (Complete I- "1 � APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued .-L[I 5 1ST ?IAApplica+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 Ordinanc N 549. JOB ADDRESS AND LOCATION... - --v*-!7-------- ----•--- -----•-- ------f," `' ------------------------------------------------- Owner's Name -------------------=� ---------------------- - Phone Address------ ------ -----•-- ------------------ -------------------------------•---•---------„---------------------•-------------- Contractor's Name .__ - r ---------------------------------- Phone- ._'_ . Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-j___ Number of bedrooms Number of baths _..-. Lot size ------- ---------- Water Supply: Public sysfem'� - Immunity system ❑ Private:❑ �6e-p h to Water Table & ft. ° Character of soil to a depth of 3 feet: 7 Sand b. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: Yes-❑ No J(4- --I"dew Construction: Yes ❑ No s _TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_(__Distance from foundation _ Material---�----- - -- -------- No. of compartments-------L-------------Size---�i, _1S .d•---Liquid depth-._4---L-------Capacity----81-x-`17------- Disposal Field: Distance from nearest well Distance from foundafion---Za..._..._:Distance to nearest lot line__f_ ......... Number of lines--------- Length of each line--X--4V- _'_ Width of trench-�- __,_____________________ Typeor filter material_______r -----------Depth of filter material.._.!,'" Total length___._--9---------------------------- -- Seep ge Pit. Distance to nearest well =,Distance m fou ation_T ___...Distance to nearest lot line/t.-__...._ �.�� Number of pits.___._-___.___----Lining material-��Size: Diameter_;�,1K-------------Depth-_s 57---____- -__-- Cesspool: Distance from nearest wel __ __..____jQistance from foundation .: :Lining material_____. ------------------------- ❑ Size: Diameter ........... == -------------------- ------------ ------Liquid Capacity--------. ------•-----------gals. \ , Privy: Distance from nearest well----------------------------------------------- Distance from nearest building------------------------------------- ❑ Distance to nearest lot line-- ..'-----------------------------------------•-------------------.--- ----"----------------------------------------------------------- --_ i Remodelingand/or repairing (describe):------------------------------------------------------------ •--------------------=---------------••-------------------•-------------------------._... ------------•-•---------------------------------------- -••---------------------------••-•------------••-----------------------••------------•-••----------------------------------------------------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances: Sta vt , a rule regul ions of the an Joaquin Local Health District. e - /6ZZ- w:� Contractor) (Signed)•----- ------------------------- ----- •-------------------------------- By� -I -----------------•- ----- ---------------------------------- •----(Title)-- ------------•- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ --------------------- ' DATE----- �-� . � � 1 f REVIEWEDBY---- •------------------------------------------------ -- ------------------- -------- --------------------------------- DATE.--------- ------•--•--•-----------------•---....----------- BUILDINGPERMIT ISSUED------------------------------------------------ -------------------------=---=------------------------ DATE------•-------------------=--------------------------------- Alterationsand/or recommendations------------------ -------------------------------------------•---------------•------------•----•---------------......--------------------------------------- --------------- • -------•-• •---------•------------•------•------------•--------------- ------ ----------------------------------------•------------------------------------------------------------------------------------------ FINAL INSPECTION BY:_- Date. Y 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 Revised W-2100