12722 - Laserfiche WebLink

Home Browse Search

J _ �S 1 c .�_�7- APPLICATION FOR SANITATION PERMIT Permit No. ---- ---- (Complete in Duplicate) Date Issued - -Sla-�_.. Application 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. JOB ADDRESS AND LOCATION------------------`-----✓ f`� ----- : f. .._ Owner's Name--'�'--+C - 1n"� = = L� hc1 = - Phone. r Address -iN�t.1 _ul-------- -----------------------_-- ---------------- - -----------------------_- --------------- Y - 1 , Contractor's Name--- ' = ------ Phone.. ---------------------- installation will serve: Residence ❑ Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ OtherC'(nu�tc l Number of living units: .''`- Number of bedrooms __�_._ Number of baths __z__ Lot size __l_`_ ____X__�} a------------------------ Water Supply: Pub#ic#system ❑� Cammun'ity system '❑ Private4E- Depth to Water Table _--:.____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑_ .Clay Loam ❑ Clay E] Adobe Hardpan ❑ ' Previous Application Made: Yes ❑ No M New Construction: Yes .EZ No ElFHA/VA: Yes E] No TYPE OF INSTALLATION AND#SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance fro nearest °_Distance from foundation___i_U_________.Material__�_t? ,_1LrC �_ No. of compartments---------- ----_--- Size_ _X_R•`•• ± --�.---Liquid depth--------_�______________Capaclty_.KOC_- � Disposal Field: Distance fronn nearest well___ _Q.`.--*:.Distance from foundation---til=--........Distance to nearest lot line_R�P(�.. ® Number of lines-------Zr----------------------Length of each line--- ---------- of french------ - __'!_-__________----- Type of filter material_-_rl _ ---.____Depth of filter material_____ -____:_____Total length-----!_ C___________________________ V� _. ; Seepage Pit: Distance to nearest well-------------------------Distance from foundation--------------------..Distance to nearest lot line----------------- Nu.mber --_______--____.Number of pits----------------------Lining material ------.Size: Diameter-----------------------Depth-------- ---------------------- . Cesspool: t• -Distance from nearest well------------------Distance from foundation----------_-------- Lining material-----------.------------------------- , _Liuid Capacity ❑ Size: Diameter----__:::_'--- ------.---------Depth---=- =-------------- --°----------- -------- q -- ---------•-------------- gals. Privy: Distance from nearest well------------------------------------------- _. _ ----Distance from nearest building :---.------- -------------------------- . ❑ Distance to nearest lot liner----- -----T--------- --------- ----------------•- ------I--------------------------------------------------------- Remodeling and/or repairing (describe)------------------ ---------------------------;�--------- ------------------------- •----•----- ..... i -' - - ------ - = -------- ------ ------- --------------- ..------------- ---:��~_ - ---- - ------------------------------------ =---._....--------- .... I hereby certify that I-have-prepared this application and that the work will be done in accordance with San Joaquin Courity__ cs, tate laws, and rule$ and regulations of the San ;faaquin Local Health District. ordinane � -_ ' --- -- 'l- : _ Owner and/or Contractor, �/ 4 -----~---�--` -- - -=---------'--------------I-- __Title Gam.-------:--�--,-•-•--—,- ;------------- - (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 lktl APPLICATION ACCEPTED'BY_ _::�.__*.- _. .. - 5�------- =------ - - ------------------------------- __ DATE----`-------------------------------- ------------ REVIEWED BY------------=-------------- DATE BUILDING PERMIT ISSUED --------------------- --- -------=--- -----•--------------:---------- DATE Alterations and/or recommendations.-------'�. .e•-�-.-------�-�—�'t'�-�x,._----- 4...5------..�-fi_sL-A---- -------------- t----------------•-•• ` ► - , -------�-V --------E-n--�-t �- -----.�.� �. �' --------- - ------ --------------------- (mss --------------------------------------------- ,-------------- ---------------------- ----------------------------------------------- } f _ 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-9-2M Revises 1-57 RP.CO.