4660 - Laserfiche WebLink

Home Browse Search

APPLICATION POR SANITATION PERMIT Permit No. . . .__�. (Complete 'in Duplicate) ! a a _ Date Issued t 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 Orclin e No. 49. , JOB ADDRESS D LOCATION. ---------------------------------------------------------- --------------- Owner's Name -------- --------- • -- - . ---- --- • ----------------•-•---- ----------- -------------------------------------------- Phone--- ------------------------------- Address----------------- -`---------A--------------- Address-----------------7 = Contractor's Name -=--------------------------- --------------- Phone_---------------------------------- 3 Installation will serve: Residence Apartment House ElCommerci lI E ] Trailer Court ❑�Mat I El!:C Other E]i �•} Number of living units: __1_--- umber of bedrooms%3--- Number of baths ._1---_ Lot sizeC i Water Supply: Public system Community system ❑ Private ❑ Depth toWafer Table .------- ff. ( ! Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loan: Clay Loam El ;Clay E] Adobe Hardpan E]Previous Application Made: Yes E] No New Construction: Yes o D f . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank orcesspool permitted i ublic se r is available within 200 feet.)f t Septic nk: Distance from nearest well_- _.'�_._ `ist je fro &oun jIion---1.0_--._.__-_Mate 'ai -------------------------- No. -------------------------------------No. of compartments-_-_- ........ '� Li uid e th__ .----___-__Capacity..- ------------- qI/�fi p , Dispos Field: Distance from nearest well _ _ _ __ _. ._ -,stance from foundationL(l -,stance to nearest lot, line i___ Number of lines---------- Length of each line _. idth of trench_-_._t-59— ..... �I .; 9 Type or filter.material- ___ ____________ ____Depth of filter material_- 1--- Total len fh_" �_ Seepage Pit: Distance to nearest well_--------------------Distance from foundation--____._.----_-----.Distance to nearest}lot line-----._--___.._ ❑ Number of pits________ __________Lining material----------. _ - ------- Size: Diameter------------- - ----Depth---------------------------------- Cesspool: - -=---------------------------- Cesspool: Distance from nearest well-----------------Distance from.,foundation-------------------.Lining,material-____----Y_.,.-�'___._ .__,_ .-�- Size: Diameter----- --._._ •-.Depth-----------_-'. =_-- Li uid`C acit t ` ❑ -------------- q p Y--=----: = -gals. I - - ii Iprivy: Distance from nearest well------.-------- '-----------------------------Distance from nearest building -- 4 ---------- - -------- Distance to nearest lot line-----'------=---------------- - Remodeling and/or repairing (describe):---------------------------------------------------------•------------------A-------•-------------------- I--------•--. --•-•---------------••---•---•--------•----••----------•------•------------------------ -------:---- ------------------------------------------- --------------------- ---------------------------------•----------------------- - + ------------------------------------ -------------!--------- ordinances, St to ws, and rules and regulations of the San Joaquin Loc # _ __ _ __ _ _ b_______----------------------- _----------------------------- ----__-_---. I hereby certify that I have prepared this application and that the work will be done in accordance with San•Joaquin County 9 q �al Health District. (Signed) = '------'--- ------------------------------------------------------ i� � ------------------------(Owner and/or Contractor) BY: --------------------------------------------------------------------------------------------- " Title}---------- ----------------{:`._ (Plot plan, showing size of.lot,Ilocation of.system in relation to wells, buildings, etc., can(be placed on reverse side). FOR DEPARTMENT USE ONLY ' ) APPLICATION ACCEPTED BY---- - ---- --------- -• ---'----------------- - -------------- ----------s--------- -- DATE------ -----,1 --- 1;`------------------------- -- � REVIEWEDBY-------------------------- ------------------ --------------------------------------- ------ --------------------)--- DATE------------------------------k I BUILDING PERMIT ISSUED----i----------------- --------------------------------------------------------------------------------------------------------- DATE.-------------------- --------' - Alterations and/or recommendations---------------.._-._ I t I --------- ----- --------- -- --- ----}---- --- ---------- --------- -------------------------------------------- ----------••-----------------------•-- -- _ --------- ` - _ . : ' i� --- -------.- - t ------ - -- - ------•----- - - ---- - --- -•-----� e.,. FINAL INSPECTION BY:.. j Date--- ------ `" fes 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 I0-52 Revised W-2100