5129 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. B' (Complete in Duplicate) Date Issued Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install thew k herein d�jjs/cribed. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION hd --- ", ,L �/ '•.. '? /'�x! -------------'--- -..---�-"� °� 1 Owners Name ------------ (�[ _� Cc?^SCI ---------------------------- Address -------------------- Phone------------- ------ ---------------------- -- Add ress-------------------------=------------------------------------------------------- Contractor's Name '------------• -------- � ------------------- -------------------------------------------- Phone----------------------------------- Installation will serve: S Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z Number of bedrooms _ _ Number of baths -------- Lot size -------.-e,7-.--------- -_ _____________ Wa+er'Supply: Public'systemX Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeIv Hardpan ❑ Previous Application Made: Yes ❑ No I New Construction: Yes, No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank;or cesspool permitted if public sewer is available within 200 feet.) 1 • ,. ..—. -.m 3_. - r Septic Tank: Distance from nearest well _/w----__Distance from foundation----lV-_ -_-.Material-------------- No. of compartments----------�------.__Size----- _,f'_ --_.+'_ ____..Liquid depth-------- Capacity !r�•Q 6 Discal Field: Distance from nearest well----- Distance from foundation---- -_.Distance to nearest lot line_-__-S' Number of lines-----r !1 -__ -----____-:Length of each _ of trench.--._..-- '� rialyi�__________ - - --_-_--_- _Type or filter mate _Depth of filter material----. .-__.-__-Total length---------- --.... Q 0 + Seepage Pit: Distance to nearest well----------------------.'Distance from foundation----.--------- ._-.Distance to nearest lot line---_--_--__.--__ I ❑ Number of.pits_____- Lining material---------------- -----Size: Diameter------_---------------Depth--------------------------------- 1 r, Cesspool: Distance from nearest well_---------------Distance from foundation------------------- Lining material__---.________.__----------____-__-_. ❑ Size: Diameter.- i-----------------=---------------Depth-------------- ---------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well_______________ __-------------__-_Distance from nearest building--------------------------------._______- ❑ Distance to nearest lot iine----------------------------------------`------------------------------ Remodeling ------------------- -----remodeling and/or repairing(describe):-------------=!----------=--•---------------------------------•--••-----•-----------••--------------------•-- - ---•--- -- rlAr _ IL — I hereby certif hat I v prepare is a cation and the work wi be done in accordance with San Joaquin County ordinances, St w an esu atio of the San J uin Local Health District. _ r (Signed)----- -----••- ---------- -------------- ----- ------------------- - --- ----- --- (Owner and/or Contractor) By:---------------------i•--------•-------------.....- ----------- ------- ------ ---------------•------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ---- ----- DATE.---- ,�� _7.5r -- REVIEWED BY----- ------ - - ------------------------- DATE------------ - BUILDING PERMITISSUED-----------:-••------------------------------------------------------------------- ----••-------------- DATE---------------------------------------------- Alterations and/or.recommendations:-----------------------------------------------------------------------------------------------------------------------•----------------------- ----------------------- ------------------------ ----------------------------------------------------------••------------ ----------- -------------------------------------------i x FINAL- INSPECTION BY:...'---,-------------- Ti__ lleC 4----- 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-9-2M ; ' Revised W-2100