4936 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. __--__LL_��-_ .-3 (Complete in Duplicate) Date issued 04"J41:s� Application is hereby made to the San Joaquin Local Health District for a permit to con stru#and , K the work herein described. This application is made in compliance with County Ordinance No. 549. Ec.,E LIC" !� S'T- - JOB ADDRESS AND OCATION___I Owner's Name------- 04 �— �-- Address_.._.-- --1 Pho ---------- ------------- - ----------------------------- Contractor's Name--- ------•------- -----------•---------•"---.. - -- -----•-------•-------•------- - ____________ __ _____ - ------ -------------------- Phone----•-------- -- Installation will serve: Residence •• � � " - --------- artmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ IOther Number of living units: -A-- Number of bedrooms " Number of baths __.-/- Lot size _ __ 4'• 1 Water Supply: Public system ❑ Community system Water Character of sail to a depth of 3 feet: Sand ❑ y Grave❑I ❑PrlSandoaQe❑ to Loam Clay ft. Previous Application Made: Yes NoConstruction: ❑ Y ❑ Adobe Hardpan ❑ ❑ New Construction: Yes No ❑ 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---1-00---Dista ce from foundation__._._f�__ f No, of compartments__. 1 'I Materi "_ P/c-c�s� Size A...- ,--Liquid depth------- --- - Disp al Field: Distance from nearest wellf pis}ante from foundation_ _ Capaci#y_, 100 Number or lines--------- -+0+ --Distance to nearest lot line -"" Z---------------__ Length of each line----- _~1f'(_ ¢ .Width of trench.._ d_!f r Type of fitter material--5-T"4-Depth of filter material-----IS Ir ----"---- �1 Seepage Pit: Distance to nearest well------________ .......Total length__-.___'�� _ _ --____Distance from foundation--------------------Distance to nearest lot line M M ❑ Number of pits----------------------Lining material-------------- --------size: Diameter-----------------------Depth------------------------- Cesspool: Distance from nearest well----.______--___Distance from foundation--------------------Lining material--.________-_____--_______-._ .___ __., ❑ Size: Diameter------ -------------------------------Depth--------------- _ Liquid Capacity.----" ""_-- - - ------------- Privy: Distance from nearest well ___________"-............................... -_--- -------gals. ___________________Distance from nearest building I ❑ Distance to nearest lot line------ g ------------------------------------I---•------------�---- --------------------------- mIing and/or repairing (describe): c ,1♦--- - ------------------------------------------------ --------------------------------------------------•------------•---------•-------------------------- 1 hereby certify that I have prepared this application and }hat +he work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Sign ed)..__V__• ; - - (Owner and/or Contractor) a=-- - ---------•---------------------------- (Plof plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT U5E ONLY APPLICATION ACCEPTED BY----------- --------- - DATE------------ REVIEWED BY------------------------- --------- ------ - - - -- ----- - --- � - BUILDING PERMIT ISSUED ---- DATE---•---- 'r- y" ----------------------------- ----------------- ---------------------- ------ DATE-- ------ �--------------- Alterations and/or recommendations:--_ _--- ----------------------------- FINAL INSPECTION BY----------------- - - - " C� � - ---- - 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 Manteea, California Tracy, California E5–w9-2M f0-52 Revised W-2100