5920 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _� .---.•_ ---- [Complete in Duplicate] Date Issued Applica+ion 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 OrdinanCoNo. 549. JOB ADDRESS A D'LO AT]ON 3 = , ' ---•-•----- = - A"' .-.. --------------------- Owner's Nam i. :_ / -D:r- Phone-- Address ---------------------- ---------_--- ------------------------•--•------ ------------- _ �� ` ' ----------------------------------------------------------•--- Phone..------------------ Contractor's Name-------------- � �� 7/� Installation will serve: ;Residence Apartment,;-House ❑ Commercial ❑ Trailer Court [I Motel [:1 Other ❑ Number of living units: ---/-- Number of bedrooms^ __. Number of baths _/-____ Lot size --- --------____________________________ Water Supply: Public:system ❑ Community system ❑ PrivateA Depth to Water Tablef�-/o ft: Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam El Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ NO New Construction-. Yes No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.] Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------.-------- Septic Tank: . No. of compartments---------- ---------------Size--------------------------------Liquid depth------------ -------------Capacity.--------------------- Disposal Fi d: Distance from nearest well_ - Distance from fcundation_y�L1_______-.Distance to nearest lot line_�.________ Number of lines----I-------------------- - Length of each line----_---��1------------Width of french------ ------------------------- Type of filter material_ � -_Depth of filter material-_/�-��_-------Total length----------,-'7 ---------------- n {U Distance #o nearest lot line--___�_.-___ Seepage?Pit Distance to nearest well---7�.___---__Distance f orr} foundation__ _______.-_;.__. Number of pits----I----_______--__Lining material _ ^< -__.Size: Diameter----.,T_*----------.Depth--------1�; --______________ Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material___.________---__,___________-_____. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------------------------- from nearest building------__-_-________________--______--_-. ❑ Distance to nearest lot line---------- --- ------------- - emodeling and/or repairing (dejcrib�-_- --; ..--------- � " ....��? _ ; `•`"----- --------------------- --- - ------------ ---------------- -------------------_ _• -•-•- ; f .S' 4 I hereby certify tha ve t is app is ion and that the work will be done i actor ce ith San Joaquin County dinances, a laws, r�s nd regulations of the San Joaquin Local Health District. = Owner and r Contractor ,- (Signed)•------ - --- --� rl,��- .. r �/� ------------ --- Title i [Plot plan, showin"g size of lot, location of system in relation to wells, buildings, etc., can be p on rev" se sie FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY--w ---------.------ ------------------------------------------- ---------------------------- DATLO~ REVIEWEDBY------------- ---- ----------------------------------- -------------------------------- DATE f V-------------•-----------. --------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------AA- --------------------- --------------------- Alterations and/or recommendations:____--------------_-.. .. {) x A_------- [ ;r• ", r,� .;rEi � !------ - i e- ------- -- ' ---- ------- -- --- ---- -------------------------------------•--------------------•----------------------------------------------------- ------------ Date �.: FINAL INSPECTION BY------ - -------------- -- ------ --------------- •-•- -- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California " ES---9-2M Revised W-2100