13636 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. --------------- ----------------------------------------- (Complete in Duplicate) --------------------------------------- Date Permit Expires 1 Year From Date Issued ate Issued .__.. ............ 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 Ordinance No. 549. - JOB ADDRESS AND LOCATION----- Owner's Name------ t__./V -,5Al_f�_'�................... ------------------------------ Phone...................... Address---32U,5--- .... --------------------------•--- - Contractor's Name k--7-3,•------•------------•-------------••---------••----.------------••---.----------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .:/...__ Number of bedrooms __J.. Number of aths -21,6- Lot size ----- Wafer Supply: Public system Yj Community system E] Private Depth to Water Table _4W—ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes g]--No ❑ FHA/VA: Yes ❑ No 92--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2DO feet.) �c S-, f' T nk: Distance from nearest well_AQ..._--..Distance from foundation_3a�____..-_.Material.. �`�'�'a_ •- nhes' No. of compartments-------2-______ ______Size------ ------Liquid depth____.-----------------Capacity-•.1.Z°O.r.._. Disposal Field: Distance from nearest well.T -------Distance from foundation...k............Distance to nearest lot line..tg�.__._.._ (^j [ Number of lines-------------- ----------------Length of each line-----7V---_--------------.--Width of trench-__zY. --------------------- O Type of filter material..:7�4.k______--_Depth of filter maferial_1 "______________Total length----1 .._.-------------------------- r. Seepage Pit: Distance to nearest well)/?__ . _____________Distance from foundation to nearest lot line 15' i __------- Number of pits—...�_----___Lining material.__`�oC.A-------Size: Diameter.....a,;�------------Depth-------------- _ _ Cesspool: Distance from nearest we€l_________________Distance from foundation------------------- Lining material___._-.._______-_-_-_--.--_____._.... ❑ Size: Diameter--------------------------------------Depth------ ---------------------------------------------Liuid Capacity-------------...............gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.-._________-_--_____.__-_-------._.- ❑ Distance to nearest lot line---------------------- Remodeling and/or repairing (describe)______________________________________ ? ------------------------------------------------- -------------I.—I-------------------------------I...--•--•............................----------------------------------------------------------------------------------------------------.....---------------------------- ----------------•---.----------- --------------•------------•-----••------------•------••--•-•------- --•-----------._------•---------•-------••---•----•-•-------------•------------------------------- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations f the San Joaquin Local Health District. �- (Signed)-------------------------------------------------------- --------- ------------------------------.-----------------------------------------------------(Owner and/or Contractor) BY= -------- -- ----- ------ -- ------------------------------------------------------------(Title)--------------------------------------------...- -•----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y.- T ./,5fOR DEP /MENT U ONLY APPLICATION ACCEPTED - -----•----- DATE-------•-1._ ..' REVIEWED BY -----------------•--------------- ---------- DATE - - BUILDINGPERMIT ISSUED----:�- ---------------------------------------------------------------------------------- DATE----------------------------------------- J and/or recomme4stions:-------------- -- -------------•-------------------- -•-••------•--•---•-------------------••---------......•------------- ^ ��. . - _ ... ----------------------------- ::__-----__::__- ----------•-•-•---------- ----•-- •---• • . FINAL INSPECTION BY:.. ... '....... �-------------------------- Date.--- SAN ate.------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak STrest 124 Sycamore Sfrest 305 West 91h Street Stockton,California Lad],California Manteca,California Tracy,California ES 9 REVISED 8-89 RM 6-E1 ATLAS �Y'