6153 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .__L�.ls...��.. (Complete in Duplicate) 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 compliance with County Ordinance No. 549. JOB ADDRESS A.WD CTI --- A...--- �d----�.. ---- '� Owner's Name *----- • -----_ Phone--------- - - Address-----QWAO -------------•--•----......-------------•-------------------------------------•------ -------- Contractor's Name__.___ PhoneZ.4.�_l. Installation will serve: Residence Apartment House;❑,, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of living units: _1---- Number of bedrooms -.. Number of baths ._-f. Lot size _.f ...Ad_.ZA ----------------------- Water Supply: Public system t1--community system ❑ Private ❑ Depth to Water Table SV. ft. w Character of soil to a depth of 3 feet: -Sand F-1Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ ardpan ❑ Previous Application Made: Yes ❑ No Am--New Construction: Yes ❑ 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 _ Distance from foundation.._./A........Ma rial.. _. No. of cam artments____ __Size__ . `! *__ Capacity_: p �.------------- L�►-�-'f-�---::Liquid depth--�-- --- - -- �------ _ Disposal Field: Distance from nearest well .Distance from foundation !...Distance to nearest lot line-J-4 . Number of lines----------- _Length of each line_-..r� Width of trench.. Type of filter material__ _ __, Depth of filter material_______j8____APO_.__Total length------ Q_____ __________•-_-•-_- Seepage Pit: Distance to nearest well----------------_-----Distance ; f ndation.... Q_�.. iancj to nearest lot line I ' Number of pits----I-------- ----_Lining material-. 6".-_.Size: Diameter--- -�:------Depth---- .4b..#---------------- 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):----•- --•-------------•-----------------•-•-----•-•------------•--------•----------•-•---•--.---•--------.....---------•-----------------•------•--.. -•----••------•--••---••••••---•••-• ------••••---•--••-•••-•------•-----------------•----•---------------------------------•--------------------•------------------•--...----------------------•-•-------------•-•-•--•.---- Ihereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,kate laws, aqj rules `d-regulations of the San Joaquin Local Health District. _ t (Signed)---- -.. _. (CSN ;:7� ntracfior) ------ - --- By:---••A94 -yr1 ----- -- ---- ----•- -------------------------------(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 APPLICATION ACCEPTED BY---------------------------------------------- ---- ----------------------- DATE -- ✓3—_2r. ------------ REVIEWEDBY.................. ----•------------------------- ----------• ---------------=-------- . DATE............................................................ BUILDING PERMIT ISSUED.....................................•••. •------•-••-----• --- DATE............................................................. 'Y tr Alterations and/or recommendations:---------------------- I ----•--•----•--•---------•-•-•------------•-----•-•------------ ----•----- .................. •-•-••.-••----•----•-•••-••••••--....-•---•••------•---•------•-••--•---••-•--------••..... -••---•------•----•--------- -------•---------------------•------••---------•------ ----•---- ... -----•-•------•-------•----•-------•-•--•----••---•----•-•---•-•----•-•--------•-•--•----••-------------------•---------•-•--•---------•-----------•-•----•-•--••--••--••---•----------•------...----------....._--- ...... --.------•------•--------------------•-----------------------•--------•--•---•--------...---•••• --.....................••-••-•--....--••••••---.........---....--------•---•-----.......••------••--•-••••......-•-•••••--- FINAL INSPECTION BY------- --------- (.,..... --••--• Date................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SouW American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9= 4sed W-21