5927 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued This a mica is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in 'compliance with County Ordinance No. 549. herein described. JOB ADDRESS AND LOCATION---------------------- 7 F - ------- --------------------- Owner's Name"--•-----------------I•----------�� '1+ 1.""..�q.,,,� Address - - ----•-- ----- ----- ---- �----�------ ------------------------ Phone----• ----------- ------- ---- ---- Contractor's Name I� Installation will serve: Residence ik ----Q--- 11 - - ---------------- -------------- ------ Phone Apartment House ❑ Commercial Number of living uni 1 : -------- ❑ Trail r`Court ❑ Mote!❑ Other ❑ Number of bedrooms .__2- Number of baths ._"_"""" Lot_size ____"" � Water' Supply: Public system Y ❑ Community system Private ❑ Depth to Wafer�Table __�►Sft. Character of sail to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam 1 Previous Application Made- "Yes ❑ NOA New Construction: Yes No ❑ Y ❑ Clay ❑ Adobes` Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: A i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well_ ��// ------A10 Distance from foundation--_".")(}_____•" No. of compartments._.----+�---------" Material-------- """ iw _ Size `� JX�-----•-Liquid depth----------YA Disposal Field: Distance from nearest-well"__- fl"-_"-" �r -----Capacity___. $ �, Number oif lines----______._._ Distance from foundation-_--- - ----""- Distance to nearest lot line_ ___ �- ------"--Length of each line-------1 ---( --Width of trench------� /! Seepage Pit: Distance titer material_"- ;��._" -Depth of filter material-----_-/ -------_ - yp or fi - Total length----•---/�------------------------ of ----- - -- s io nearest well."___"--_""__."__"_:"Distance from foundation------------_.-""".".Distance to nearest lot fine--""__"-__"."____ ❑ Number olf pits_-----_----_"_.--____Lining material_ . Size: Diameter--------- -.--..Depth---------- \, 1 Cesspool: Distance jr°m nearest well -_---__-Distance from foundation--------------------Lining material______________ V ❑ Size: Diameter---- -------------------------------- ---- ------ �----- �--- 4 _ _ --`Depth---------------------------- --- ----------------------- fig a� Liquid Capacity- ------------- Privy: Distance from nearest well-----,-.""-------------------------- "-- Y ---gals. .l. --=---------- ----""-_" ""__"Distance from nearest building ❑ Distance to nearest lot line----- *. g---- -------------------- --------------- T' ------- Remodeling and/or repairing (describe)----------------- -------------------------------------------------•-----•- ---------------------------- --------------------------------------------------------- ------------------------------- #t I hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin Coun li ordinances, "..""..-..�" --- -laws, and rules and r?glatiOns of the San Joaquin Local Health District, ty (Signed) ------------------------------------------(Ow 8y:. -----------I� (Owner and/or Contractor] - (Plot plan, showing size of lot, !kation system in relation to wells, buildings, etc., can be placed on reverse side). (Title)--.-,----------------------------------------- ofIN FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�M_____________ REVIEWED BY---------------- IN: ----------------------- DATE------ - - ......� BUILDING PERMIT ISSUED_----_ilk -- - -- - ------------------------------------ - DATE---------- � --- ---•----------------------- -------- -- ---------------------- ------------------- t A aerations and/or recommendstions:-_ - ------------------------------------- DATE."".-_-----.-_"""-- ------------------------------------------ , ---------•------ �- f r ---- 1 ��1c�,c-- ----------------- -- r•--------- _ F -------------------- FINAL'INSPECTION BY:-------. ----------------------------------- Date------- ---- -----------^f 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California 814 North "C" Street Manteca, California Tracy, California E5-9-2M Revised W-2100