5702 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR Y R SANITATION PERMIT Permit .� {Complete in Duplicate} -� Date Issued�D._:-�•-�•_�� Q` 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 wi!jh County Ordinance 549. JOB ADDRESS AND O AT10N ---- - V Owner's Name_ ---- /----- � - 1 - _ !-_YPhone- d i� Address • ---7�-------- '�-- e17 . tZ Contractor's Name ---1_�. �.5!/ /-V_ ---------------- Phone_ 9- --- ----- Installation will serve: Residence 19 Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --f-.--- Number of bedrooms __Number of baths -/----- Lot size _ -_ ,� Water Supply: Public system Community system ❑ Private ❑ 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 ❑I No X Now Construction: Yes ❑ No r:•ice 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__.--_-__----:_------_- .__. 1-1 tS�lNok of compartments artments Size--------------------------------Liquid depth---------------- --------Capacity----------------------- Disposal Field: Distance from nearest well-,----------- -- Distance from foundation--------------------Distance to nearest lot line----------------- ❑ fix'S tr Number-of fines-----------------------------------Length of each fine----•---------------- -------Width of trench.------ ------------ - Type of filter material-------------------------Depth of filter material-----------------------Total length-------------------•___-_-- 9 -----------_--•- Seepage Pit: Distance to nearest well-- !LC 'lx....Distance om foundation-_ ------Distance to nearest lot lin Number of .-" _--__Lining materia _- _ Size: Diameter-� --------_------Dp _- _- -•----d-- ------Cesspool: -- Distance from nearest well from foundation------------------- Lining material-:_----.---------_-.---_-_ ❑ Size. Diameter-----I------------ -------------------Depth---------------------------•------------------------Liquid Capacity----------------------------gals. ❑ Privy: Distance from nearest well-___-----__-------------------------------------Distance from nearest building Distance to.nearest lot line.......... --------------------------------------.-m------------------------------------------------- Remodeling and/or repairing (describe):------ ----I f - -_ --•-•-------- �J -------- -- j---------••---------------------------------•-•-------------------------------------------------- ---------- ---------- ------------------------------------------------------------------------------- -----------------------------------------------------------------•------------•----------------- I hereby certify.thaf:t a prepared this a plication and that the work will be done in accordance•with San Joaquin County ordinances, State laws a d rul s and regulati% of the S Joaquin Local Health District. (Signed) -------- --- i ---- { r Contractor) x _- ran By:..------•-------_----- -- -- -- (Title)- ? -------------- ----------- - - of plan, showing si a of lot, location of system in relation to ells, buildings, etc., can be plc d on reverse side}. i ` FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY_V ---_ DATE. ____________________----------- ---------------------------------------•-------------------- REV l ED BY - ------------------- -------------- ------------------------------------------- DATE__ .--------••---------------- - BUILDING PERMIT ISSUED ----------------------- ------ DAT Alteratio s and/or recommendations:--. �; - _- --__- - =--------- -- - /p._--.�-9-- ` -�-------------------- -------------- ----------------- ------------------------------------- ----------------------------- --- --- - --- ------------•---------------- --------------------- �1• 1 FINAL NSPECTION BY:...!_I`- -�-°2s_._ ------------------------- 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 . Revised W-2100