4551 - Laserfiche WebLink

Home Browse Search

�r APPLICATION FOR SANITATION PERMIT Permit No.4eG5_.6__/__ (Complete in Duplicate) ,p Date lssued�__ 3__P/ ':3 Applica+ion 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----- Owner's Name-------------------------------------- Address.. sty�a✓2.. f?? iia. --- ---- - ---------- - -- ------------------------------- --•---------------------------------------- ----- (� ) ------------ ". l, 1X1k Contractors Name ---- rKJ J---------------------•-•---------------------------------- Phone--- ------- Insfallation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I_-_- Number of bedrooms .J_- Number of baths ./4 Cot size ___ _ -D._r .__ty'r _______________ Water Supply: Public system ❑ Community system ❑ Private X. Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe * Hardpan ❑ Previous Application Made: Yes ❑ No tK New Construction: Yes)e No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu4lic sewer is available within 200 feet.) Septic Tank: Distance from nearest welly/Q-..-_-__Distance from foundation__I.O_f---------Material------ ------------ No. of corn artments_. I- �'1�o_-_-jp,qK � 1 p Size_ " - " _ Liquid depth„ a �� Capacity Disposal Field: Distance from nearest well__SP.�_._D1sfanc.from founclation___.11.0'------.Distance to nearest lot line_- Number oflines-------;fi------------_----_--------Length of each line_____x_,57.5_'_______-Width of trench.-____vZ_6_c_.-.-_._.______..- Type or filter material---lyk._I�lG-----Depth of filter material_._ �' ofaI length_- -/_ `____________________ �- Seepage Pit: Distance to nearest well----------------------Distance from foundation__-.__...-_-....___ Distance to nearest lot line----------------- El Number of pits------.--------------Lining material-----------------------Size: Diameter-----------------------Depth__-.__-_..._.______-___.-_------ lJ1 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 _ - -_F'le�- ----_--- --------•I — ----------••------------------------------------ ----•--------------------....------------------------------------------•------------------------------------------ ---------------------------•--•------------------------- \ ---------------------•------------------------------------------------------------------------------------------------- ---------------------------------•----------------------------------------------- I hereby certify that I ha prepare is application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule nd regula ' ns of th n Joaquin Local Health District. --------&_al�Lfls --- -- -- --- --- ----- --- ------- -- ------------------------------------------ (Signed) Contractor - ---- ( �f By:--------•----------------------------------------------------------------------- --- ---- ---- ---�----(Ti+le---- (Plot plan, showing size of lot, location of system in relation tow Is, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- DATE REVIEWED BY------------------------------------ -- ------ c.� DATE �- z� BUILDING PERMIT ISSUED--------------- --------- --------- DATE Alterafions and/or recommendations.--------- -- --------------------------------------------------------------•-------------------------------------------------•------------- ---------------------------------------------•------------------------- ----------------------------------------------------------•---------------------------------------------------••-------------------------------- ----------------------- ---------------------------------•-----------------------------------------------------------------------------------------------------•---------------------•--------------••-------------_----- -----•---------------------------------------------------------------•--- ---------------------------------------------------------- ----------------------------------------------------------- -------------------------- ---------------•-•-------------------------- - -----------------------.------------------------------------------------ -------------------------------------------------------------------- -------------------------------- FINAL INSPECTION BY- -------------------------------------------------------------- Date...... 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 10-52 Revised W-2100