21579 - Laserfiche WebLink

Home Browse Search

s FOR OFFICE USE: --------------------------------=------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .�2 _ -------- ------------------ ----------- - ------------ (Complete in Duplicate) -; -- ----------- This Permit Expires 1 Year From Date Issued 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 applicationismad�ntornDlianr_n--1 .,County Ordinance No. 549. we..3)" S!aA QNB 47— jOB Owner's Name---•- ••--- l j_.R- �^it °-----AN- one 0 � , W Address------------------ 4'- a x 40 P- I,� tJ-�( = :_=r_ .— `_ ------------- --------------. Phon &(,_ Contractor's Name_________.._ �� Installation will serve: lResi.dence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -L___ Number of bedrooms _it- Number of baths __I---- Lot size _ _____________________ #; Water Supply: PuOic system ❑ Community system ❑ Priva+e g Depth to Weter,.Table.2 _ ft. Character of soil to a depth of 3 feet: Sand [�L Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑j Previous Application Made: (If yes,date ------) No � New Construction: Yes ❑ No�HA/VA: Yes ❑ N0 9 TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: "q Distance from nearest well-----------------Distance from foundation__.--___-I______._Material ❑9k414*No. of compartments------ -- ------------Size--------------------------------Liquid depth------ - ---------------- Di Capacity �Lk• Dispos I Field: Distance from nearest well__. 1JDistance from foundation--- to nearest lot line__ -r /��-a 1 ' Number of lines---- ______ [f.�_ --- ----Length of each Iine�Z7 r_:___. ?��_..Width of trench.___�� t Type of filter material ____ __ ____________Depth of filter material---`_- `___ - -----.-Total length__ _ -. ,q� Seepage Pit: Distance to nearest well______________________Distance from foundation_ __-_____________.Distance to nearest lot line--.__._________ .�.....�.,�❑.�.�..�.. Numbe.r.of pits---------- -----------Lining material--- L-------.-- --------Size: Diameter--.--------------------Depth---------------------------------! . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------- ❑ Size: Diameter- ------------------------------------Depth-------------------------- --- --- wLiqud'Capacity "-- ------.gals. Privy: Distance from nearest we]-------------__`............................... ._Distance from nearest building-----____--__________-__________.- --__-i ❑ Distance to nearest lot Iie Remodeling and/or repairing (describe]:______. -------- -"_�------ -----•__--_--_- -- ---- -------------------- ------------------ ------------------------------------------------------- ------------------------- ------------------------------------------------------------------------------------------------------------------------------- --------------------- - -------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County` ordinances, State la nd rules and regulations of the San Joaquin Local Health ��District. I ' (Signed) 1 ------r-- - -- ;�.-1 ll ---------- (Owner and/or Contractor) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY �+ 7 APPLICATION ACCEPTED BY - --------------------------------------------------------------- DATE---,-?— - f 4 REVIEWED BY------------------------------------------- ---- DATE----- ------------- t BUILDING PERMIT ISSUED---------------- - DATE. Alterations and/or recommendations:--------------------- - -------------- ------------------...------------------•---------------•- !I --------------------------------------------------------------------- ------ -------------------------------------------- ----------------------------------------------------------------- --------------------------------- -------------------------------------------------- ........ ---------•------- - ----------- --------------------------------- -------- --- --- --------- FINAL INSPECTION BY: Dae-_-------------------- -f SAN ' JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California - Manteca, California Tracy, California F.P.CO.