11729 - Laserfiche WebLink

Home Browse Search

111"— _ �,� � U APPLICATION FOR' SANITATION PERMIT 7 Permit No. __.1_!__:.__ (Complete in Duplicate) Date Issued l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. h This application is made in compliance with County Ordinance Yb - y l -,L.C.�% s Q -------------------------------- JOB ADDRESSTL,?CA ION--------`�-------- ---- �------ �--------- -- -- : ---------------------------- Owner's Name--- - ----------------- ------------------------------------------- Phone ------------------------------------ Address---------------------------------------------------- = ff Contractor's Name________________ _ ------------------------------------ - Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ ��Motel ❑ Other El _.. Number of living units: _/.__ Number of bedrooms___ Number of baths ---tl-_ Lot size__1-.-_`Sa----------- -------------------- Water Supply: Public system �Commuriity system ❑ Private ❑ Depth to Water Table ' S- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 21 ---Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [ rHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) grk: Distance from nearest well ------ .--------- Distance from foundation -------------------- Material __..____-_.___.---------- _-------------------- - oNo. of compartments------- ------------- --Size---- _------------------------- Liquid depth -------------------------- Capacity..----------------- --- I Disposal Field: Distance from nearest wel_ �:�____ Distance from foundation________.Distance to nearest lot If�e___ ❑� Number of lines ----- ----1__---- Length of each line--_-------ii------.Width of french --,2-5/ ---------------------- Type of filter material_ �- .fit -G ---Depth of filter material__ ______ ----Total lengthJl1r_______ �--------------------------- {11 [� µ y _____.Disian /e to nearest lot e - - � �------ Seepage it: Distance to nearest well- A16 foundation_______. Number of pits------�------------- Lining material_------ -Size: Diameter________- --------- ----..Depth----C------------------------ 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 ------------------------------------------- -------------------------------------------------------- ------ ---- --------------- ------------------ --- - / Remodeling and/or repairing (de Scribe)::__ ai ------- - - --------------------------------- --- ----------------------------------------------- ------- ----------------------------- ------------- ----------------------------------------------=------------------------------------------------- ----------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t to aws, and rules and regulations of the San Joaquin Local Health District. ---- (Signed) wner and/or Contractor) - ------ ------------ --- L .� {Title)- _A________�_________ ________ ________________ By:----------------------------- ------ -- (Plot plan, showing size of lot, location of system in relation t el s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ - ------------------- DATE `- 02 �� --------- -------- REVIEWED BY------------------------- - DATE BUILDING PERMIT ISSUED ------------------------------ -------------------------------- DATE--------------------------------------------------- —`1 Alterations and/or recommendations- ---------------------------------- } ------- *----------------- -----------------------------•-----------------------------------------•------------------: -- --------------------------- - ----�------- - -- ----------- - ---------------------------------- �- orf+ ------------------ /__Q L -• 1 _7 - ------------------------ --- --------- 7 --- -------------------- ------------------------ I ------- - - FINAL INSPECTION BY:- Date r�--r-�.-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30o West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5 -9-21M . Revised 1.57 F-P.CO- ■