6115 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ---. ll y•-•-••. (Complete in Duplicate) Date Issued,.* /� +- is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h ein described. Applica ion y This application is made in comp iance with County Ordinance No. 549. .J �d-fat- -. JOB ADDRESS AND LOCATkON__lSt-M_iL -_.-tea - ---C. ---- - -lrli�� .----°- '------ _ '-4-_ --------C -'-------------- - �' s_1/ 5 ----------------------------------------- -----------• ----------------------= = Phone Owner s Name.-------G-�=-----;• -- _ Q- --••-----------••`-------•------- ------------ Address A?_l.c.r- I'.------A& �. �_ �' .-�_,f_ ------:1-e'' � / Phone------------------------------ Contractors Name--------s�['z- ----------------------•----------------------------------------------• -----------••--------------------------------- installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livsng..units: I--_- Number of bedrooms _ ----- Number of baths J.---- Lot size _��--�--1�'Q_---•------------------------ 3 Water Supply: 'Public system ❑ Community system ❑ Private jo Depth to Water Table 70-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,{ Clay 0. Adobe❑ Hardpan ❑ Previous Applicafion Made:. Yes El No. 15K New Construction:„Yes }No ❑Y= _.. . .,� ,3 N _. .• .-_� TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank,or cesspool permitted if public sewer is available within 200 feet.) _e-T , r - Septic Tank: Distance from nearest well_. -Q- Distance from foundation_-Q- ----.Matenal_ lam° - -- r-•-------------------• No. of compartments-__ - - Size, 7------ -------Liquid depth .. Capacity... Disposal Field: Distance fromJnearest ell-.�lt�' '.}Distance from foundation_J� '. "-._--Distance to nearest lot line- - ...- �)}�;r IN Number' of lines- ------r�/F�or - ------ Length of each line._-)„ a-42--------.-Width of trench- !----------------------- (� pq V� Type or filter matenaliZ!/s!-__hQC�-----Depth of filter material-/ _y .--Total length---- ,;P-_Q_f--t-------------------- Seepage Pit: Distance to nearest well .------w-__-- ---Distance from foundation--------_-----------Distance to nearest lot line----------------- Number of pits- -----=-------- g Dp�� El ------Linin material-----------------------Size: Diameter---- ------------------ epth----- -------------------------- -sl - Cesspool: Distance from nearest well-----------------Distance from foundation_._.-.----_-._..a_-:Lining material------------------------------------- ❑ 5ize:.Diameter De.pts_ ---- _ _ .r� LiquidCapactY .-. - gals- _ mss-- _— � i✓.: - 4 1 Privy: Distance from nearest well--------------------------------------- ---------Distance from nearest building------------------------------------------ fi .�.. .FF - ❑ � Distance to nearest.lot line-------------------------------------L---------------------------------------------;---------- -------------------------------------------- -- Remodeling and/or repairing (describe)-------------'-1-:f.-V-- ------------•----------------- ------------------------------------------------------------------ --------------------------------------------------- ----------•--•---------------------------- -------- --------------•-----------------------------------------------------•----------------- ---------------------------------------------------------- 1 hereby certify that] 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. r.._r�.-.-- - - ----------------------- --- (Owner-and/or Contractor) -- (Signed ---------------------------•-----;----------------------- .---. • le) < ; ---------------- By---------------•------i----=•=---------...---...!-.------------------------------------------------------------------------------- ---------------------------••-------------- ------{Tit ------------•----------- ----------------------- (Plot plan, showing size of lot, location cf system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I` -- DATE.. _ Com. .-- APPLICATION ACCEPTEQ BY_-_- -- ------ --- ----- DATE-- ----------------•-------------------- ------------------ REVIEWED BY 1 BUILDING PERMIT ISSUED--------------------- - ------- DATE Alterations and/or recommendations--------------------:- - -------------------------------------------------------- ------------------------------------ ......------..._...-------•----------- t -------------------------------.---------------- ----------- ------------- --------------------- ------------------ --------------------- -----------------•-----•------••------------------------------------------------------ . i -----� �------•-------------- ---•------------•-------••-- ---- -------------- EFINAL INSPECTION B :. --. .,-----., -------------- -- --------- Date-'..- ==----------- -------------------------------- -• ------- --------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street, 132 5yeamore Street . 814 North "G" Street _. Lodi, California Manteca, California Tracy, California Stockton, California / ES-9-2M ; ' Revised W-2100