2855 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Per- it No., ___.__u_____._... 3 d �- z (Complete in Duplicate) Date f Issued �/(/_5_� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This cation is made in.compliance,4with County Ordinance No. 549. (� �_rgp—p elg lQ� �./elle EJI�.» C 494 I OFN JOB ADDRESS AND LOCATION/ __IE,�O_ �4.1:r---- --f. --.---/1if1hP.__ Ed s_---±P�,C1tf._ ' '�i1 ---- � Owner's Name------ -A M. R_.t---------/-�•------•-----rr—A ^ Phone 3,7 Address--------------------------- '-- �Ql'C-----�-''�-�--------�-��.��-L,�_e� ---------------- ------------ --------------------------------------- Contractor's ----------------------------------- Phone_" 4, _ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:,Number of bedrooms �__ Number of baths477A_ 6o+ size _/49 -- r- ----------------- Water Supply: Public system ❑ Community system 0 Private Depth to Water Table 6Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan Previous Application Made: Yes ❑ No �( New Construction: Yes x 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_ Q__--______.Material___ _____ .�_______________ No. of compartments�W-�-----__-5ize_: _= ---Z-QaLiquid depth___,�� _______.___Capacity_ _!�p-___�`--_- - _.__._...Distance to nearest lot line-.��_'_.. Disposal 1"ield: Distance from nearest we{I_�-__----Distance from foundation__. � Number of lines-- +-- t�- --Length of each line___-__-- �� ---Width of french-,. ----------------- Number of filter material__ __ _ � ,De #h of filter material_____/X-_`____Total length-- ________________�_ 1 � -- - p y� Seepa a Pit: Distance to nearest well----&&-_____Distance from foundation_ &______.Distance to nearest lot fne__1�+:,1_ Number of pits_C-'-`:"'______Lining material-�0+_(err_-Size: Diameter_ , " Depth�`� ------- ., 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)--------------_ __ `'"p ---------- ----------- -----------------•----•- ---------•------- - --------- - --- ------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepay this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and re ulations ofZ__-1....San Joaquin Loc .. Ijealth District. e a -- -----------------------------------------(Ow er a . /or C ntractor) (Signed)------ t BY >° i----- -----(Title)- ------------- ------- -- ---------------------- (Plot plan, showing size of lot, location of system in relat an to wells, buildings, etc., can be pla d on reverse side). FOR DEPARTMENT USE ONLY �--/�--� ---------------------------------- --------------------------- DATEACCEPTED BY___- (/V --- - ---- REVIEWEDBY----------------------------------- -------------------------------------- -------------------------------------- ------ DATED----- -- BUILDINGPERMIT ISSUED--------------------.--------------------------------- ------------------------------------•-----:---- DATE-------------------------------------------------------------- Alterationsand/or recommendations---------------------------- - --------------- ---- ----------------------------- -------- ----------------------------------------------------------------- -------------------------------------------------------- ---.----------- -------------------------------------•------------------------------------ ------------------------------------------------------------------------------------------------------------ ----------------------------------------- ---------------------------- -----------------'-------------------------------- ------------ ----------------------------------------------------------- ---------------------- ----------------------------------- - --------------------------------------------------------------- l ' FINAL INSPECTION BY: � Datej 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 8-51 Revised W-2100