3059 - Laserfiche WebLink

Home Browse Search

iGGG/ rfl .jc F3 �� APPLICATION FOR SANITATION PERMIT Permit No a i (Complete in Duplicate) Date Issued 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 r l �`�y --------------------�"-Ll �--/�'i y-- Owner's NameR`9-�6C---------- ---------------------------------------------------------- ------ Phone---` Jr Address-------------------------------------- ��-------- ----- '� --------------------------- Contractor's Name-------------------------------------41`"_ _ �---------------------------------------------------- -------------------------- Phone---------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms ._�- Number of baths _/_-. Lot size ------ ------ Supply: Public system ❑ Community system ❑ Private A Depth to Water Table ft. 7.5 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes* NoNew Construction. Yes No E]x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within`200 feet.) M1113 Se ti Tank: Distance from nearest well___.-�_____Distance from foundation____ .�-Q----=---.Material---tt7l� ----No. of compartmenTs___________z'-------Size__s X_ K�___--Liquid depth-----------4__--__-- ____ F 44 Dispo I Field: Distance trom nearest weiL__SQ_---.__.Distance from foundation_____/�__�____.Distance to nearest lot line____��____ ' ei Number of lines ')-4r— a'�`"� Length of each line______________—------o------Width of french__________ _ -______________ rt Type of filter material-_1.y`r_� ____Depth of filter material------__,�_?.________Total length________________�__ Qf_-_-__--- Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------.--------Distance to nearest lot line----------------- El ______-_- -_❑ Number of pits----------------------Lining.material-----------------------Size:,Diameter-----------------------Depth--------------------------------- r Cesspool: Distance from nearest[] well.-----------------Disttance from foundation___________________ Lining material ___________-_----__________--_____ f Size: Diameter---------------- ---- -----------De th---------------- - - ---- ----- -------Liquid Capacity--------------------------- also; .r+ Privy: Distance from nearest well---------------------------------------------- --Distance frorn nearest buiiding------------------_.------------------- ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stats, and rules and re tions of the San Joaquin Local Health District. (Signed) """- -- �-E -------------- ------------------------------------------------------- --------------------Owner and/or Contractor) By:-------------------------------------•---------------- -----------------------------------------------------------------------"(Title)-------------------------------------------------------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �1 APPLICATION ACCEPTED BY------------------------------W --- DATE________---__ _ }j� --------- ------------ ------------------------ -�----��----�---�-------------- REVIEWED BY------------------------------------- --------------------" -------------------------------------------------------------- DATE_------- BUILDINGPERMIT ISSUED-------------------------------------- --------------------------------------------------------------- DATE------------------------------------------------------- - Altera ions and/or reK--o-- m�ndations: -------------------------------""-""-------A--------------- = *� ter-- . . "" !' , . f L4 -r : _________________ _______________________________________________________________________________________________________ ---------------------------------------------- --------- _------_______-.______-___ -_ ----__.___________.__._-_------________________________-__._.-.-__-____________________._._________-________________ 6-j FINAL INSPECTION BY:-------- -------------------- Date----7.13 F 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 ' r ES-9-2M B-51 Revised W-2100