7245 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. 4-21 (Complete in Duplicate) 3 Date Issued _-_-��--- 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 compliancewithCounty Ordinance No. 549. JOB ADDRESS AND LOCATION____,.)_ _3_.6-_ _�_�.-_-___- -/ /_ 'j L A/ - --------- ---------------------------- ---------------------------- Owner's Name----- - r' Address-----------.��__-.A7AV___�—'�___- - ----------------------------------------------------------- ------------ ----- ------------------------------------ ------------------------------------------------------------------------------------- -- Contractor's Name : �j 1� j_51 ... ft�C t -------------- -- - ------------------------ - ----------------- Phone!�_---,e7� G-7 Installation will serve: Residence EZ!-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -. Number of baths _J._ Lot size Water Supply: Publics stem D f pp y: y [.}' Community system ❑ Private ©'' Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septicnk pr cesspool permitted if public sewer is available within 200 feet.) s K Septic Tank I- IDI ante from nearest well-- ------ ------Distance from foundation------------------. Material----- ------_-. ❑ No, of compartments.-- - ---Size--------------------------------Liquid depth - ---- --- _. Capacity------------------ Disposal Field: Distance from nearest well_ .�. ..-� Distance from foundation.-. J -/_....Distance to nearest lot Iiine__Z.0_�___ [A` Number of lines---------------- Length of each line____--. .a_..�. -_--.Width of trench...-._2-s/_'f.-___ Type of filter material.------��- S0f.Depth of�filter material____-11--------- _Total length--_-.-_�-"- Seepage Pit: Distance to nearest 4L_40-0 -.-_Distance from foundation----- ----------Distance to nearest lot line.__AQ--`____ EA- Number of pits_ - _Lining material_0r(' Size: Diameter___ �f - Depth- �'f------- 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._ -- - "V ❑ Distance to nearest lot line-.__._. -____ --------------- - Remodeling and/or repairing (describe)--- ---- --------- ----------------------------------------------------------•-------------------------- -------------------- --------------------- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, at laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Ar --- - er and/or Contractor) ------ - ---------------- -- - --- ---- - - --------------------- - (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---- ----------------- - - - --------------------------------- ------ DATEREVIEW _ ---------------------------------- ED BY--------- -------------- ------ ----------- - - - ---- -------------- -- ---- - -- - - ----------------- --------- DATE----- ----- -- - - ---- - --------------------------------------- BUILDING PERMIT ISSUED----------------- -------------- --- -------------- -------- DATE. - --------------- Alterations and/or recommendations:----.--.- FIN . AL INSPECTION BY:_-_-.. Date--- ..:. t.. ' 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 ,2-54