2456 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT. 'Permit No.a'`/j {Complete in Duplicate} ar Issued - /.5 �, Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal[the work•herein described. ' This application'is made in compliance with County Ordinance No. 549. f JOB ADDRESS AND OCATION___..-----� /1/0----- -s ---------------------------------- Owner's Name___- - -.I , .--. Gi cy ro Phone__---------------- ---- Address /p ------------------�- Contractor's Name ..... ,� - -------------------- ------------- -----------=�'------------ Phone----�`"_��__r�..--��------- i w installation will serve: Residence{ Apartment House ❑ Commercial ❑ - Trailer Court ❑ Motel ❑ Other Number of living units: ___l__ Number of bedrooms __— Number,ofbaths I---- Lot size -__�,Q ❑ Water Supply: Public system ❑ Community system ❑ Private Depth.to Water Table ft. } Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No &,„-:,MNew Construction: Yes ❑ No.,& .TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) lit Septic Tank: Distance from nearest well r ." __-_-Distance;from _._foundation_- e r��______.Material__- � No. of compartments-----------2-.-----------Size----S�4X_3-4_-------Liquid depth----sr-3Capac�tY 4 -- - ra c Disposal Field: Distance from nearest well__- A`-_.-Distance from foundation.----�{�---- --Distance to nearest lot line__-f__.__ Number of lines__--------- ___ ,, ._-- Length of each line---- ,--------Width of french------ `` -___ Type of filter material____ ____ _--Depth of filter material------ length ..� is--=' --------------- --a- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------D'istance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h--------------------- ------------ esspoa: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------- ❑ Size: Diameter--------------------------------------Depth---•--------------------------- -------------------Liquid Capacity. gals. Privy: Distance from nearest well________________________________________________Distance from nearest building ------•-----•------------- ❑ Distance to nearest lot line____.------------------------------------- ~ Remodeling and/or repairing (describe)______________ 4 -•----------- ------F---- -------- -- ---------•------------------------------------------------------------------------ -------------------------------------------------------------------------------- ------- -•- --- -- --- ----- --------- - ----- 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 and''regulations of the San Joaquin Local Health District. (Signed) t✓ L. BY: a ------------------- - � r Contract (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 APPLICATION ACCEPTED BY------------------ ------ – DATE REVIEWED BY------------ DATE---Z---^ "" •.. ------------- / - BUILDING PERMIT 1551JED DATE r-- -- --------------- - - -Alterations ------------------------ and/or recommendations:__._____________ _ ----------------------------------------- ----------- ------------------------------------ ----•---- ---------------------------- ------------------------ ----- ----- ------------------------------------------------•- FINAL INSPECTION BY:_________--- ► - - ' '. �3 "� ------ ------------------ - s; Date-- SAN ate- -L.- ------ " SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca,.Caiiforma Tracy, California ES-9-2M 8-51 Reviser! W-2100