7441 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ... (Complete in Duplicate) 7 / Date Issued X7f¢_sZ__ a 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 Cou di ceN . 549. JOB ADDRESS AND LOCATION--- ----- ___ ----- ------- ?------ er_hz �,,� � t �---A41 fit Owner's Name--=--' ----------------•----- ------------------------------ Address Address-------------01-.- - c �� 1 � --- ------- - -------- d Contractor's Name-1Q.,- � C. �.J 0-/-Vs-------- ---------------------------------------------- Phone-------------------------___-----__ Installation will serve: Residence ® Apartment House ❑ -Commercial [] Trailer Court ❑ Motel ❑ Other ❑ ". Number of living units: Number of bedrooms fir_ Number of baths --- Lot size -----Z------- ------------------ Water ________________Water Supply: Public system ❑ Community system ❑ Private [Q- Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pj_ Hardpan ❑ r Previous Application Made- Yes ❑ No 1�4—New Construction: Yes [ 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----- from foundation.....L4_f.____.Material---- __Kf_-4 __---_--_. r r/ No. of compartments-----�--------------Size__' __Z'�-- -- Liquid depth----- -- ------.-.--CapacitY___-__. ----------- Disposal Field- Distance from nearest well__- _-�-Distance from foundation_ ______-Distance to nearest lot line._____-_____ Number of lines----------- - -- Length of each . Width of trench-___ rl _________ ' esType of filter material__1Depth of filter material lengthf _______--______--__ it Seepage Pit: Distance to nearest ________Distance from foundation-------Zq&__Distance to nearest lot line____/_Q__/__ Number of its______ ______-. . ___Linin material__�_['1 �' ___--______ p / g Diameter__-- -:--- ----Dept - i ------ Cesspool: Distance from nearest well-----------------Distance from foundation-----_------------_Lining material__--_____-__-_____-___--_________. ❑ Size: Diameter----------------------------- -------Depth--------- ------------------------------------------Liquid Capacity-------------------------•--gals. ",Y, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------- _-__________- l� C] Distance to nearest lot line.............--------------- ---------------- ----------------------------------------•-------------------------- Remodeling and/or repairing (describe)-------- -------------- -------------------=----------------------•----------------------•------------------- -•---• . ---------------------•------------••--•-----••--------------••-----------------------------•------•---•----------------------•--------•---------------------------------•----------------------------- w - • -••---------------------------------•-••------------------•------------•------------------------------------------------------------------••-•-•---------------------------------------------•------------------•---------- t -------------------------------- -----------------------------•--------------------------------------- -------•-•-----•-------------------------------------------------------•----------------------------------- 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 of the San Joaquin Local Health District. Si ned 4' ----4--____ C�-?- � Owner and/or Cont actor �� ------- ----- BY� ----------- -----(Title)---� � ------------------ -- ----------------- (Plot plan, sho g 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------- - - - REVIEWED BY DATE_ J------------------------------------- BUILDING PERMIT ISSUED---------- ------- -- - ---- ------ DATE--------------- --•---- Alterations and/or recommendations--------------- .... .... ----- - ------- - ----••-------- - -------------------------- ---- - •----------- - (� -•- --- ---------f--_. ------------------------------------------------------------------------------- --------------------------------------------------------------------------- -------------------------------------------------------%— ----- ---------------------- ---- ..... -------- ----------------------------------------------------------------- } y FINAL 'INSPECTION BY: t -------•-- -------•---- Date = J_ _ ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT A 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California E5-9-2M 14S446 AT WOOP 12-54 . f