5969 - Laserfiche WebLink

Home Browse Search

y`t APPLICATION FOR SANITATION PERMIT Permit No. .- yl:: _<_.. (Complete in Duplicate) Date Issued Applicaion is hereby made to the San Joaquin Local Health District for a permit to nstruct and install the work herein described. This application is made in compliance with Cou/nt`y Ordinance No. 549. /10 U JOB ADDRESS Ay LOCATION------,ice--�.-1 I------- ---- - !--- -- �-----------------•-------•---- _+ -- --- ------- Owner's Name _11 1(�4 ------,��7—OR�-----••-•--------------------------- - ---- ----------------------- •------------ Phone I -•----- Address---------------- ldr:3es .� +. - � - Contractor's Name------------------------------- ---�� I-��.F`�----�--.LA�f_ ----------------------------------- ------------- Phone - - ---- ---- Installation will serve: Residence ❑ Apartment House ❑ Commercial K Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __, --- Number of bedrooms ,...—. Number of baths - Lot size ----.?___AA95_4-------------------------------- Water Supply: Public system ❑ Community system ❑ Private CA Depth to Water Table _.t_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 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.) t t Septic Tank: Distance from nearest welllP__-_-Distance fr foundation_.3--- Material._ ___ __________________ q lJ No. of compartments--�__.__..- Size_ �c.-- --f.Ur_____-._--Liquid depth.+ ,r4+--------------Capacity.. ---------- P Disposal Field: Distance from nearest well....----_._._....Distance from foundation----------_----------Distance to nearest lot line----------------- F1 Number of lines----------------------------------Length of each line-----------------------------Width of trench---------------------------------- Type of filter material-------------------------Depth of filter material-------------------..--Total length-------------------------_ -------------- , Seepage Pit: Distance to nearest well-1O0-r---------Distance from foundation_,__------------Distance to nearest lot line--AO-------- o , Number of pits.--------Lining materiaL... A tr/' __.Size: Diameter__j-3.N_____---_--Depth--3 ----------------------- Cesspool: -------- ----Cesspool: Distance from nearest well-----------------Distance from foundation_..---------.----__.Lining material_-------.-_______---______________- A'a ❑ Size: Diameter--------------------------------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals. \ I Privy: Distance from nearest well--------------------- ---------------- - -----._Distance from nearest building = -------------------•------------- Distanceto nearest lot line.. -------------------------------------------- ------------------------------------------------------------ -------------- --- --- Re -- ReY_ f eling and or repairing describ �:-- !- -------- +�'- -t �_ .Wy ...?/G " _f / __� t._,s---�---Come��--- ---��'+ �-----��I_f7_'& 4/-----W,---Z c..A---B� _J-- -- A51/r P"d""-----AA-Z-A•----------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------•------------------------------- -- ' I hereby certify that I have-Imeniared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a r les a regulations of the San Joaquin Local Health District. � � � (Owngr a /or Contractor (Signed)------•---------- B ' (Title}- G. r� By:. = (Piot plan, showing size of lot, location of system in relationeeils, buildings, a+c., can be pla don reverse side. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-'---,------------------------------------ --------------------------------•--------- - DATE ---------..---------------------------------------- s�M REVIEWED BY-------------------------------=--u---P-- - ------------ ------- -------------------------- -------------------------_ DATE__p----------------------------------------------- BUILDINGPERMIT ISSUED...------------------------------- ------------------------------------------- ------ DATE-------- ------ Alterationsand/or recommendations:-------------------------- ------------------------------•-----------------------•-•-•--------.-..---•---------------•---•----.--•----------------•--•------- -----•----------------------••-------------------------------------------------------- -------------------------------------••----------•------------••-----------•----------- - --------------------------------•--•------ -----•-----------------------•-•-------------••-------------------- -••-------------------------------------------•---•-------- •----. ---- -------------------------•------••-------------------------------•--------------•----------- ----------- --- ----------------- -•-••---- Date------ •---------•--- -------------------------------------- FINAL INSPECTION BY - 1 ---'--------------- 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