9292 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ____9-- ----q-----2- ----- (Complete in dupllic7jite) 7 Date Issued 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 Cou4y-Ordinance No. 549. � . / ---------- --- --------- ----------- JOB ADDRESS AND1OCATION__=__1_ -- - T ... Owners Name_____W__t L, ------------------------I---- _----------------------- ---------- Phone.,A Address-------------------- ------5-a.,.-------- N----------------------------------------------------•-----•-_1.___11---------------------------- Contractor's Name.......I......Z---q ------- -------- Q. ---------------------------------- Phone------------je�� Installation will serve: Residence E37--Apa rtmerif House Ej Commercial [] Trailer Court ❑ l4otel E] Other 0 Number of living units: -------- Number of bedrooms %5-- Number of baths Lot size -1 :24, .7---------------- Water Supply: Public sy'stem [P- Community system [I Private El Depth to Water Table ---------ft. Character of soil to a depth of 3 fee+: Sand F] Gravel Ej Sandy Loam [I Clay Loam E] Clay C] Adobe ff Hardpan E], Previous Application Made: Yes E] No —New Construction: Yes gj.—No E] TYPE OF 'INSTALLATION AND SPECIFICATIONS: (No septic,tank or cesspool permitted if public sewer is available within 200 feet.) tj Septic Tank; ;Distance from nearest Distance from foundation__-,,'__0!-----Material---R---------:i._____________..__________. `'No. i--------------------------- ` No. of compartments,---------` -,--------Size-----c. .•---Liquid ------- --__--------- --A -L0.__Dis47`nce from founclat ----- Disl5qsal Field: Distance from nearest wellf------a ion---/_A9---- Distance to nearest lot line----L15- Number of lines------- Length of each line-----Z_e---0-.'(.......Width of trench;.___._, -Y- ------------ Igo 0 ---------------- Type of filter material----RO-C.. ...Depth of filter material.... See�age Pit: Distance to nearest Distance from foundation__A_,_�4----0-------Distance to-nearest lot line--I-------------- N:umber of pits--------- ----------Lining material I.Size: Diamefer___.3_,3_"(-------Depth------a--- --------- -x C-ess-pool: F Distance from nearest well--------------.--D;stance from foundation--------------------Lining material__..___.._______..____.______________ I] aterial------------------------------------- El Size: Diameter----------------- --------------------Depth--------------------- ------ ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------:------------------------_'. - ElDistance to nearest lot line------------------------------------------------ ------------------------------------------------------------------------------------------- Remodelingand/or: repal ring (describe):--------------------- --------------------------------- ---------------------------------------------------------------------------------------------------- ................11-------------------- -----------__;��-----------------------------------------------------------------------r----------------------------------------------------------------------------------------------- -------------------------------- -------------------•• -------------•------------------- ------------------- ----------------------m:�--------------!-!�,= "I, ----------------------------*------------------------------- ----------------------- --------------------------------:------------------------------------- --------------------------------------------------------------I -------------------------------------------------- I hereby certify that Fhave prepared this application ana,fhat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation&of the San Joaquin Local Health District. ------------------------------- ------------------- - (Owner and/ Contractor By:....... ---(Title)------------------------------------------------ -------------- --------------------- -------------------------------------------------------- ------------------------------- (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 1-W APPLICATION ACCEPTED-BY--------------- ........ DATE---------------------- ...... 7------------ V/REV --- IEWED BY-------------------------- -- - -------f------------------------------------------------------------ DATE---------i f� - ----------7-------------- BUILDING PERMIT ISSU ED--------------K----1,/ 3- A------------------------------------------------------- --------------------------- DATE..------- ----------------------------------------------- Alteri0iorip anevpri�re om mendaf ions:_A----------------- -------------------------------------- -------------------- �-S� —7- ------------------------------------------------------------------------ - --------------- A -------------- -------------------------------------__----------------------------------------------------- --------------------------------V---------- ----------_--------------- --------------- -------------------------------- ---------------------------------------- ----------------------------- ------------------------------- ------------------------------------------- -------------- ----------------- - -------------- -- ------------------------------------------------------------------------ --------------------- ----------- ------------------------------------- ----------------------------------------_-------------- FINAL INSPECTION BY:.------- ---------------4_------ Date- ---. 20!K--------- 17--------------------------- )-, - ------------- 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