2978 - Laserfiche WebLink

Home Browse Search

ll — APPLICATION FOR SANITATION PERMIT Pe it ........ (Complete in Duplicate) Date Issued `v ►Q 1i 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 Ordinan o. 549. JOB ADDRESS ALOCATION----- L--L --------9�t4_i----- -----------•------. ---------------------- Owner's NameV&_IVAILE-------- --------------------------------------------------------- Phone -- ---------- --- -------�----+--�--------�-- ----------------------------------,------•--------------------------- Address-------------------- � E Phone. --------TA_ContracFor's Name I Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:0AXNumber of bedrooms _YNumber.of baths 1_____ Lot size s74- -lQ ___________________________________ Water Supply: Public system-A, 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'�'f Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ 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_ lD_K�._Distance from f foundation---- f Materiral____ __________ _______________ 7�ll�L*-------_ Sh_:7j&__Z_D.Liquid depth---� Capacity S�Q No. of compartments_ Size_ Disposal Field: Distance from nearest weILyo—me.Distance from foundation__rf_0____-------Distance to nearest of line___ ___________ Number of lines___�r�-__--��-- -----__--Length of each line--- 1,17!__ -it------- of trench_-�_#_!!._-_-____________ r�� Type of filter material1y),4—kd ._Depth of filter material_____ __ __ _Total length_--- ------------- --•--- W Seeps e Pit: Distance to nearest well---_r?WA/4 _Diistanc�from foundation___4. .___. istin a to nearest lot line_�_�_____ Linin material__ _ ��_ __-Size: Diameter__.I-----_-_____-Depth_ Q_______________._ Number of pits---QM9- g 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 (descri �&1_ ----- ---------------- ------- --------------- ------------------ ------------------------------ - ----------- ------------------------------------------------------------------------ --------------------------------------------------------------------------------------•--•------------------- I hereby certify that I have prep ed)his applica i and that the work will be done in accordance with San .Joaquin County ordinances, Sta �aws, an rules and peg ations of th San Joaquin Local Health District. �� (Signed) _.-- -------------- -- /� ------ --- -----R__�_�_- ----- ---- ---- �.r '"= i -{Owner and, r Contractor] - ---- &.fit------- --- -------(Titlel- (Plot plan, showing size of ot, location of system in relation to wells, 'buildings, etc., can be place n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '. - � .. ----- DATE----------"�/_ L' r REVIEWEDBY----------------------- --------------------- ----------------- ---- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------ ---- - ----------- ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- - ----------------------------------------------------------------------------- --------------------------------------------------------- -------------------------------------------------- FINAL INSPECTION BY:--------�/'v ------------------------- Date----- ��- A ---"' 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 8-51 Revised W-2100