2993 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No, Y --9_-- _ (Complete in Duplicate) Date 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. 54 JOB ADDRESS AND LOCATION...—�l ---- r - --------------I------------- Owner's Name-------••----,' f�� 7ra =------- -� - ------------------------------------------- Phone---- ------------------------------ Address -h� • — - -------- ----------- ------------------------ - -- / --•--•----------•--------- - �- - ---�----�--•-----f- - - ----- .--------�- -- ---- Name `3_ ---------------------- Contractor's Phone 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f / r I Number of living units: ---/_ .umber of bedrooms -/---_ Number of baths --L--__ Lot size __ ------ �4-_------------------------- Water Supply: Public system [1/Community system ❑ Private ❑ Depth to Water Table -------- ft, � Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam (] Clay E] Adobe 4---Hardpan ❑ Previous Application Made: Yes ❑ No 0/�w Construction: Yeso ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) € Septic Tank;- Distance from nearest well/4�� istance from foundation__ -----Maten 1. ------------- [ � )9'Z�13- ------------ No. of compartments__-_ rS�ze.---„_ r!- 1-. ___Liquid depth_..-_� _�--`.___Capacity--_ � _ f' ------------ Disposal Field: Distance from nearest weli!` ._pistance from foundation- ,-- ---Distance to nearest lot line- __--. 4' G [�/� Number of lines------- -------- --- Length of each line.___-. _-- Width of trench---- -_--_- e ,� -- e f/ f f-------------------- Type of filter material.; IAN- - _-Depth of filter material--J-_ -.-----_____Total length__-----�:-_�_----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------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---------------------------------------------- -------------- ------------------------------------------------------------------ ------ -----------•---- , 4� _ .> �.- - �= - ------------------------------------- I Remodeling and/or repairing (describe)----------- -- -- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of th o an Joaquin Local Health District. 1' ! !�- l---- - (Ow eyand/ ” Contractor) (Signed} " By:.... 2 �T.C! _rr✓- ----- ---(Title)-----------------------------------j -------•------- (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----------------------I -- - ---- DATE--------- �rx—------------------ REVIEWEDBY--------------------------------------------------- - DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:----------------U---------------------------------------------°'--1----.----."-----i- - " -------------------•----------------------------------------- ----• ------ - ----------- ------------------------------------------------------------------ --------------------------•---------------------------- --- ----------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------- ------------ - ---------------------– ---------- ---------------------------------------------=------- ------------------ -- ---------- ------------- -----------------------------------r t � Date-------------V�----/.0- , sr� FINAL INSPECTION BY: - ------ 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