2436 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No:'o . :.- ---------_ 3 (Complete in Duplicate) v,ff a r b Date Issued _�_ I_P/A_-Z.) 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--•---------,x;32-4- �'------------DA]Iaa----------------------------------------------------------------------------------------------------------- Owner's Name---------N_-arry--Shaff_er-----------------------------------•------------------------------------------------------------------ Phone----37:aU g Address------------------S_-U'1e--------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- IContractor's Name------------D7eZtA------------------------------------------------------------------------------------------------------------------- Phone----x-3.9.5. -------------- l Installation will serve: Residence g� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.❑ Number of living units- _____1 Number of bedrooms __l___ Number of baths ___1__ Lot size __50x100------------------------- Water Supply: Public system ER Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: Yes ❑ No ❑X New Construction: Yes ❑ No 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----------------------------------------------._III } EXIS'JItiG No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------------ Disposal Field: Distance from nearest well-----------------Distance from foundation-------------------:Distance to nearest lot line --__----------- IS"Z1VTG Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------_---____-- N. I Type of filter material-------------------------Depth of filter material------_-----------_---Total length-----------------------------------•------It II SeepagePit: Distance to nearest well______'�Q_________Distance from foundation____$_'__________ D--stance to neares�lf e______ ___r_ ___. Number of pits----1---------------Lining material-----brick---Size: Diameter____3-�---------------Depfh ._ f-_------ ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-------------------._-_-____________. ❑ Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. H Privy: Distance from nearest well___________ _____________________________________Distance from nearest building-------_=________________________________. i. ❑ Distance to nearest lot line----------------------------- ------- -------- ------------------------------------------------------------------------ --------------------- Remodeling ----- -Remodeling and/or repairing (describe):------I] s-t-a11atiR_n- af.._.VeX r t---_ a_..la_!U_'�__141x__1"_rl h__SO_1_1d_ --------- I' -- r ---------- ----------------= ; --------------------------------------------------- i 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. i` ` (Signed)---------------------D a It----------------------------------------------------------- W (Owner and/or Contractor) fix' `rix r11 ------------------------------- Title-----Owner-s� ;r°----------------------------- By:------------------- I ) (Plot plan, showing size of lot, location of system in re[ ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -- DATE_ __-- __ REVIEWED BY------- DATE-------- - ---------------- { BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------ ----------- DATE--------------- ------------------------------------ Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------__--------------------._--...__.._. 1 ---------------------- �. ------------------------------------------------------------------------------------------ _--- ------------------------------------------------------------------------------------------- ------------ --------------------------------------------- ---------------------------------------------- FINAL INSPECTION BY:-----------r ------------------------------- 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 k ES-9--2M 8-51 Revised W-2100