8145 - Laserfiche WebLink

Home Browse Search

i , t APPLICATION FOR SANITATION PERMIT Permit No, 0 (Complete in Duplicate) 0I- 4'Ll Date Issued ___�._/I.�/�_._ 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 Or mance No. 549. JOB ADDRESS AND LOQATJO = _ = ------..... -_------�f-- .:_.. 1_ �-- 1C Owner s Name 6tj-- --- one----•------------------------------- Address............................... .�----•-l = '- `-'_t ``=- Contractor's Name............ ____ f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j----- Number of bedrooms Number of baths ._/_.... Lot size =5A__'._X----------------------------------------- Water Supply: Public system ❑ Community system ❑ Private j Depth to Water Table ./S: ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe . Hardpan ❑ Previous Application Made: Yes E] No A New Construction: Yes E] 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_________________Distance from foundation....................Material_--_-_-_--_._ ____- -.-----_______ .-. I .._ Elf=1K'S' �J No. of comp .artments_--__.. --------- -Size-----------------------------__Liquid depth______-____- _..___-____Capacity---------- -- -- ' Disposal Field: Distance from nearest well - ------- --_Distance from foundation...«----------Distance to nearest lot line_. ( E Number of lines____Z�=t — _„_.__ -.Length of each line __•_cp"0 _. Width of trench ¢__`_�_________ J `rKC 9 f ---- Type of filter material_/5' -_.-_-_-------- of filter materi l -----------..Total length.__..._. .............•_......................... Seepage Pit: Distance to nearest well -_______-.-_.___Distance from foundation--------------------Distance to nearest lot line_-------------- ❑ Number of pits______________________Lining material----------------------.Size: Diameter-_-__---__--_- __-_-Depth________._-_-___---___-___- Cesspool: Distance from nearest well...._------------Distance from foundation--------------------Lining material-------------------------------------- El -_ --.-_.❑ Size: Diameter--------------- ------Depth------------- --------•----- _-------------------Liquid Capacity •--- -•gals. Privy: Distance from nearest well------.-------------. _______ _______ __ ___ ___Distance from nearest building-------.---------------------------------- El ____,_____ ••-• --_ --___-_.❑ Distance to nearest lot line-. ----- •--------------------- -- -----------•----•- -------------------------------- ---------------- ----- -- -- Remodeling and/or repairing (describe):_....._. _....__ f ------------- ----------------------------------------------------------------------------------------------•----------------------------------•-------------------------------------------------------------------------•--------------- I hereby certify that I have pre re this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, anyrules d gulations of + San Joaquin Local Health District. �� 1 �(Signed)•------------------------------ ' ------ ° ` ----- (Owner and/or Contractor} t. d==---- l'�` G�:z_�.n �-- Title J - ( � )-- (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be place"n reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- -•- ----------------------------------------------------------------------•------ DATE�,�................................------------------ REVIEWED BY---------_---------_-------- - DATE =� -'----- VN BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE-------4�y -' _.-_.------- -------------.----------•--. Altarati and/or eammenda+ions -- 3�E 1 ,. �y r v -- - 6� .. ....__....._ ........................... .. --------------------------------------------------- e ......... ... ................................... ...........•-_---.--.--.._.....___.___.--..----__.-._-.__---_--_..-.-__..-___----___--_-..-_--_-----.--___•--__---_-_-----___--_---_---.----_---.-.--_-_---_---._._..__ r ' FINALINS ION BY:. ---- -------------------------------------- ------ Date------------------------------------------------------------------------------- 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-9145446 ATWOD�