2740 - Laserfiche WebLink

Home Browse Search

Pe0j_ ` Permit No- ------------------------ �f APPLICATION FOR SANITATION PERMIT om lete in Duplicate)-� � �Ci p p ) Qate Issued 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. JOBADDRESS AND LOCATION----------- 22---S --D:,?a aP- ------------------------------------------------------------------------------------------------ FOwner's Name----------------•----------- 7---=----------------------------------------------------------------------------------- l Phone- - TaQ----------------- Address----- ----------------Address-----------322__x.* -------------------------------------------- --------------------------------------•-------------------------------- ---------------------------- j95-5� Contractor's Name_---------fieVi -- ----------------------------------------------------------------------------------- Installation will serve: . Residence ffl Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: .____ Number of bedrooms 2_____ Number of baths _i-____ Lot size ___50'=15 -------------------------------________ Water Supply: Public system M Community system ❑ Private ❑ Depth to Water Table 3-0-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No)❑ New Construction: Yes ff] 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----- from foundation___10r__- ____.Material-_-- C-@r1eL-'�^------------------___- t t 1 5 L„;r ® No. of compartments--------2_______________Size.S_:-��__.a _____--.Liquid depth----�--�.-]---.--------Capacity_BQC?------------- Disposal ______ ---Disposal Field: Distance from nearest well-----------------Distance from foondatien--------------------Distance to nearest lot line________________. ❑ 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___-noTLC:-------Distance from foundation-----3-W-------Distance to nearest lot line_.5_____________ fl Number of pits____J----------------Lining material---b:':Lc1------Size: Diameter-______ %20_........._---------- _ Cesspool: Distance from nearest well-----------------Distance from foundation----------------_._.Lining-material ____________------_______-_-_..____ ❑ Size: Diameter--------------------------------------Depth-----------------------•----------------------------Liquid Capacity-----------------------------gals s Privy: Distance from nearest well-------------------------------------------------Distance from•'nearest building------------------------ ❑ Distance to nearest lot line--------------------------------------------------•---------------------•-------------------------•------------------------------------------- Remodeling and/or repairing (describe):------EN -----------------------------------------------•--------------------------------------------------------------------------------------••- -----------------------------------------------------------•------- •-------------------------•--------- —4. . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County L ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -------De_1l-•-a------------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:------ Y3�..w»-----------------------___.______-____-__------________-___________._________-_____--_Title}____�%_s'1 - ='_" -v 7� _______________-_________-___ i' (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__may- - ---------------- --------- --------------- --------------------- REVIEWED BY----------------------------------- DATE - --�--------------------------------------- ----- --------- DATE----�--------------•---------------•----•------------- fBUILDING PERMIT ISSUED--------------- ----------------------------------------------•--------------------------------------- DATE------ --------------------------------- Alterationsand/or recommendations:------------------------------------------------------------------------------------------------- -------- ------------------------------------------------ ----- ---------- -------------------------------------------------------------•------------------•---------------•-- -----------•-----•-------------------- -------•------------------------------------------------------------------------------------ -------- I' Date FINAL INSPECTION BY:--.--5//-------- ----------------------•--------------- -------------------------- k 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-4-2M 8-51 Revised W-2100