9335 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. � arf)Vxx /4?1 � (Complete in Duplicate) 1i Date Issued App ication is hereby made to the San Joaquin Local Health District for a permit to construct and ins all the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--______.`h�_/. _--- ----- G,X----- .`1. ----------- C/p�'_ -----_ ''`da Owner's Name -_ --__SCJ. 5", 1. �------------------------------------------------------------------'------ Address-------------------- Contractor's Name Name--------- .__ "/1� �s t P' -�� f--------- ------ Phone__ -- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel-[� Other ❑ Number of living units: --- Number of bedrooms _, Number of baths ---/__ Lot size ��_____- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --------- Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam.❑ Clay Loam ❑ Clay ❑ Ado eK Hardpan ❑ a t r Previous Application Made: Yes ❑ No�M New Construction: Yes No E] PHA/VA: Yes ❑ No,PV- 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------ O------Dista' nce from foundation_,._/rQ---------Material_ ! fC � No, of eompar#menu......... ------------;_Size----- _ _ Z_" Liquid depth-----� 2r__-________Capacity____ s _ Disposal Field: Distance from nearest well--- Distance from founciation___==:=___._.Distance to nearest lot line---LaS__.._-• 1- Number of lines.---------/- -- ------------Length of each line--- �D___ --.Width of trench-------- _ 4I------------ ' i Type of filter materiaf------- A_C./---Depth of filter material___../eF----______Total length---------- fid___________________._ Seepage Pit: Distance to nearest well-_/0-0..._____Distance m foundation______ .. ._..Distance to nearest lot ® Number of pits------1-------------Lining material----- �� Depth---- --------_----- QC�-Size: Diameter_____.: Cesspool: Distance from nearest well________________Distance from foundation._.-_-______.____.Lining material----..___________-_.______._-________- < ` ❑ Size: Diameter------------- --'-------- ------------Depth-------- -------------------- --------A----'- A-Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well__.____________________._____._____.__._._______-Distance from.nearest building--________________.__-__--------------_- � ❑ Distance to nearest lot line = ------------------ h----------------------------------------- -------- ---------- Remodeling ---- ---Remodeling and/or repairing4(describe): ' -------------------------- ---------------------------- ------------•------------------- .ti ----------- --J----------------------------------------------------------------- _1 ------------------ -----------------•--------------- -- ----------------- ------ ------------------------------------------------------------------------------I- --------------------------------------------------------------------------- -------------------------------- -------------- I hereby ce ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws nd rules and regulati of the San Joaquin Local Health Disfrict. d Signe L a ; i { g ) --- �7�, -------------------------Owner and/or Contractor) i By: f =-------------------- (Ti+le) �✓*zr ---------- i (Plot plan, showing 'size of lot, location of system in relation to`well Iii gs, , can be placed on reverse side). I FQR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ; -----1---=------------------------------------ = DATE ��)REVIEWED BY------- ----• ------------------- ------------------ DATE------ ---`• BUILDING PERMIT ISSUED---------------•----_---- - -�. __ I - - DATE------��.�-- ------------:-----------------••--•------- Alter/ations and/or recommendations: ------------------ ----------- -------------- -------- Y L----- �--- / f - �-:---------- �1 � ' e •Sr -�"-- �G !1 {_�� --------------`{ e , f _ t ------------------------------------=---- - ----------- --------_:--- --------.----------------------------------------------------- r NIX INSPECTION BY:------ :�°�:�r" Date---------- �� \f v ,� 7 ----- I �SAN JOAQUIN LOCAL HEALTH DISTRICT , k 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 Revised 1.57 FRCO.