5573 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ` Date Issue l _- -__-__- Applica}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 Qwith County Ordinance No. 549. JOB ADDRESS AND LOCATION.-----.d I-1_—Enc//?.C?------------------------------------------------------------------- ------------ ---------------- Owner's Name---------------------------- ;T1------- _P)-------- -------------------------------------------------- ----- Ph ona l Address-------------------------------------------------- C3.Cn6-- -- Contractor's Name---------------------------- CdreC-,SA------ I7lc-•---------------------------------------------------------------- Phone-h6_47- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I___ Number of bedrooms _;F-' Number of baths _-/_ Lot size ___ ------f_�t_�_--_____________ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No 19 New Construction: Yes ❑ No ❑S'w�P�� Br7�d1�*ajlt.�/Ntli�7t7l e TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ptic Tan : Distance from nearest well-----------------Distance from foundation--------------------Material_______________-___-___.______________________- Ig li') No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity----------------------- Disposal Feld: Distance from nearest well..q.A. __._Distance from foundation__1__P----------Distance to nearest lot line___l�_ __ W., Number of lines-------/----- --------- -----_---Length of each line-_/0------------------.Width of trench.J_Q ..................... --j- •� - 4 Type of filter material___I_X1-------------- Depth of filter material----/_g_.!........Total length___/47_'---__________________________ Seepage Pit: Distance to nearest well___-l?----------Distance from foundation_j/.�%____-_-.Distance to nearest lot line----/D_'__ Number of pits----L_______________Lining material-�! 1 __-Iize: Diameter__- "______Depth_ 0 -_____-____.______ i Cesspool: 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)--------------------------------- -----------------------------------------•••-••------------------------------------------------------------------------- -----------------•------------------------------------------------------------------------------------------------------------------------------......------- ------------------------------•--------------------------------- -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•---------------------------------------- I h7s, Sf ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordirtante a s, and rules nd regulations of the San Joaquin Laca! Health District. Si ned - -- Contractor19 -- �d ) By:------------------------------------------------------------------ _. .._ �` ..-----------------------(Title)---�4?ray �i�1_,.e-------------------- (Plot plan, showing size of lot, location of system relation to wells, 1411dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- -------------------------------------------- DATE---------------- _. REVIEWEDBY-------------------------------------------------------------&f---------------------------------------------- DATE---------------------------- --------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------- -----------•------------------------•-----------•------------ -----------------------------------------------------------•-- --------------------------------------------------------------------------------------------------------------------------------- --------------••---------- -------------------------------------------------------•-------- ----------------------------------------------------------------------------------------------------------------------------------•---------------------- -------------- -- ---------------------------------•------------------- --------------------------------------------------------------------------------------I-------------------------------••-- V _-- Date Rm4 .— FINAL INSPECTION BY________________________________ _ - ---------------------------- ....____._. � 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