9756 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 1.7 (Complete in Duplicate) 7 Date issued __----�P�--------.. A licaa-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 County Ordinance No. 549. SWC) JOB ADDRESS AND DLLO•CATION•/,�,.a_!_1_yL�K_t. _.4�._�'1LC1-[_ - . -- ------------ Owner s Name--------- ---- wPhone ------------------------------------- Address. --'�.. ----------- --------- = - -- .. Contractor's Name ---------------------------------------------------- Phone ----- Installation will serve: Residence partment House ❑ CCoo mercial ❑ Trailer Court ❑ MotOL el ❑ Other ❑ Number of living units: __ __ Number of bedrooms ___-/� Number of baths ____�__ Lot size . _. .__.__ ___ Water Supply: Public system ❑ Community system ❑ Private XDepth to Water TableVQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [y Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction-. Yes y 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__. e_ ---Distance f 0founc��---- Materi __/__ _ ________-. No. of compartments-------��---------Size.-- ----�--C-- 7�` Liquid depth Capacity �r•��s,s r Disposal Field: Distance from nearest well...__ -_Distance from foundation_____ __-_. ---..Distance to nearest lot line._ 7___. (r7 Number of lines____._._� r -- _- Length of each line__- -ea.y�. �IWidth of trench.___.`. �._______.___ r Type of filter material.--ri' -_t__�'1_0Depth of filter material_...___-/. ___-Total length ________________ L Seepage Pit: Distance to nearest well---------------------- from foundation--------.-----------Distance to nearest lot line____-_.______-_. ❑ Number of pits----------------------Lining material-------_---------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 1771 Size: Diameter------------------------ --------- -----.Depth------------------------------ ---------------------Liquid Capacity--------------- ------gals. Privy- T Distance from nearest well---- ---------------------------------___....Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------- ------------ ------- ---------------- -----------------••---- ------------ ------------------------------------------------ �__ and/or repairing (describe)________________________ ___ /� / ---------------•-------•-•----•--•------------•--------------------------------------- --------- ----------------•------•------------------- - --------------------•-----------------------------------------------------•---------- - �''�5 iS - ---- - --- -------- ----------- ----- ---- - ------- ------ I 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 d regulations of the San Joaquin Local Health District. �r� r (Signed)- - --------------------------------------------------------------------------------(Owner and/or Contractor] By:..........------------------------!�--- --- ----------------- ------- tTitle (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 APPLICATIONACCEPTED BY----------- -- -------------- - ------- - ------------------ DATE-------- 7 ------------------------------------------ REVIEWED BY ---------------- ------------ DATE--- -- ----------- BUILDING PERMIT ISSUED------------------------------------ - ----- ---- - DATE Alterations and/or recommendations______________________ -•--------•----- -- ----------------- -----------•----------------------------------------------- - - - -- - -- - --------- - - FINAL INSPECTION BY:. 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-3 145446 A-000