8635 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. . ................... i V1. (Complete in Duplicate) Date Issued ---1__----- -�_ .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.... ,�� d r Owner's Name-------,0,0_`V-----��12� ------ xx// ---------------------------------- Address------ ++c�7�+f A10----- ��•L—..� ------------��-------------��- �-i- -•---- --.._.p..e. ........................ Contractor's Name_-• ------------------------------------------ Phone----------------------------------- Installation will serve: Residence N p rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits:--/ Number of bedrooms <,�- Number of baths _I�F-=Lot size ---_�-C :-`-------------------- Wafer ---------------- Water Supply: Public.system [] Community system) Private ❑ Depth to Water Table �ft, Character of soil to'a ldepth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,&L. Hardpen ❑ Previous Application Made: Yes ❑ No Q_-New Construction: Yes K_No ❑' -FHA/VA: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr we11--- 4Q__:_Distance from founda n__Zid-----------Material-----C:__4 _ . No. of compartments____- F Size__ _ _ "Liquid depth_____ �-----____ p y--_-., - _:-- __Ca acit Disposal. Field: Distance from nearest well.. �7 ! __:.Distance from foundation____/ __...---Distance to nearest lot line------ l�'._.___ . Number of lines---------- Length of each line____-�; .,rte_______ Width of trench____�`____�__---------- __& -�-- Type of filter material-/&-____,5Depth of filter material____._/ .�_ Total length___.______ Seepage Pit: ` Distance to nearest well__ � istance fro foundation__&A__.__..Distance tonearest lot line__.�d•l_ VCl Number of pits---------/-- Lining g material__-_worSize: Diameter- --- --a----Depth...... 7-'{-------- (Tj Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material______.________________--___________ ❑ Size: Diameter--------------------------------------Depth------------------------.---------------------------Liquid Capacity----------------------------galsdZ), Privy: Distance from nearest well---------------------------_---------------------Distance from nearest building------------------------------------------I ❑ ---------------------------- Distance to nearest lot fine--- ----------------------- ----=--------------------------------- C i. Remodeling and/or repairing (describe)------------------------------------------------------------------ -------------------------- ---------- -- 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 s, d rules and regulations of the San Joaquin Local Health District. (Signed)---- ------- -- -•- ---------------- ---------- ----- --------------------------- ---------------- - ------ --- ---------------------Owner and/or Contractor): f By: ..... ..... --------------------(Title)------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY `[ C APPLICATION ACCEPTED BY------------------------ ----------------------------------------------------------- DATE ' REVIEWED BY-------------=------------------ -------------- ` ------ ----------------------------------------------------------- DATE------ = ---r-------- -- ----------------------- BUILDING PERMIT ISSUED-------------------------=------ ---------------------------------------_---------------- DATE----- --------- Alterations and/or.recommendations:_____________________ ------'� ---------------- -- ------ -- -- --- ------------- - - ----- ---- } - - --------- --------------------------------------------------------------- -- ______________________________________________•-_____ 3 ` FINAL ----- "------------- 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-9-2M . Revises 1.57 F.P.CO.