2814 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT 14.,� (Complete in Duplicate) s-/ Permit No. _ _ _�_ .__ fi �✓ � N" Date Issued �_ ----7_.------ 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--------- S. Delmar Owner's Name------------�'k �C l q---T and � 802 0 ------------------------ Phone---------- 0------------- Address---------------------- 268 S. Delmar ---------------------------------------------------•-------------------------•----------------- ------_-------------- Contractor's Name---De)_�-6=-------------------------------------------------------------------------------------------------------------------------- Phone------3- 3-9.`a.5------------ Installation will serve: Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 2_____ Number of baths _1___- Lot size ------z.Jnib$___-_- Water Supply: Public system ❑ Community system '❑ Private ® Depth to Water Table __0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ k- 3 Previous Application Made: Yes ❑ No [Z 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 I T dG No. of compartments------------- -----------Size------------------------------ Liquid depth--------------------- ---Capacity Disposal Field: --Distance from nearest weft-----------------Distance from foundation--------------------Distance to nearest lot EXTSTUNG? Number of lines-----------------------------------Length of each line------------------------------Width of trench---_------------___-- - -------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-------._-____:_______ - ------------------ s I Seepage Pit: Distance to nearest well _____-�P0 ----Distance from foundation___-.10___. ---.Distance to nearest lot line----_:11_______ ' ® Number of pits-------I------------Lining material__brick --Size: Diameter_4F2 _----- -------Depth--------------- Q ________ 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 (describe):____---__ ns ta•11in� v_ertieG,l drain and hooking up to the ---- ----•------------------------ ----------- ------------------------------------ --------�xj_sling--- k t'' - of d 1 n e--------------------------- -- - -- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. Si ned Delta Set�t1C '-'erik S----- ------------------(Owner and/or Contractor) (Signed) -- a S - - --n --- jh/J By:_________Perry Wcrth�n � Owner--M r ----------------------------------------------------------------(Title)----- - --- --------------------•------------ mi= x (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_- REVIEWED BY ------------- DATE----- BUILDING PERMIT ISSUED ------------------ ----------------------- --------------------------- DATE----------- " Altera ' s and�.or recommendations:---- -------- --------_ ------------------------- - ------------------- -------- ------ = = = -w � -- =- - -- - ../--------------------- �_____ - '----- !')=---------- r --- - -------------------' n s� --------------------------------------------------- ------------------------I---------------------------- -------I------------------------------------------------------------ 0 -lel------------------------------- FINAL'INSPECTION BY: Date11-------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet j Stockton, California Lodi, California Manteca, California Tracy, California ES-9-211 8-51 Revised W-2100