5822 - Laserfiche WebLink

Home Browse Search

nn APPLICATION FOR SANITATION PERMIT Permit No --------`-------- \ + �� (Complete in Duplicate) pate Issued '_l0:.55� Applic n 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. C41-1 aA ffd 4)_ JOB ADDRESS AND�LOCATION...--------- --------------- ------- -------[-•�• -- - l�.!_S.-_.�_CL-t�- -V 5 ----------------------------------- - - - Cr) A�----�73�/ Owner's Name_______- _ I Phone_- Address �r L ° k 5 ��-'--A 1-6—q------------------•----------------------------------------------------------------•------------------------••---- Contractor's Name----------------------•------------------------------------------------------------------------- ---------------------------- --------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ --- Number of baths /)(9—Lot size ____ __ _O z— Water Supply: Public system ❑ Community system-❑` RrivateT1Kj Depth fo Water Table z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes VS No ❑ } TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from neo r rest well - +J__Distance from foundation_.fx_ _--____.Mafie�ial____ ' '_______________________ ❑ No. of compartments_________Z__---_._.-__Size______ ___ �__ Liquid depth _ _ __ _ _Ca acit -d--- ------ q P. -- P y------- Disposal Field: Distance from nearest well_.'�$�__._-.Distance from foundation___Zl______---Distance to nearest lo} line�S___ Number of lines_-.�------- ----------- - Length of each line------- of trench----e�2___�--------------------93 .) Type of filter material___-- _� -Depth of filter material____/_ _. `___Total length__--_--.g�jo_________________________ .i Seepage Pit: Distance to nearest well_ +____-_____Distancee fro foundation _______-2;ft nc�;o nearest IotJme__ Number of pits------- -----------Lining material C .41y/Size: Diameter_--k- ------------Depth---7------------------------- i Cesspool: Distance from nearest well---------------_Distance from foundation..----------------. Lining material_-------------------__-______-__-__-o . Size: Diameter-----=--------------------------------Depth-------- ------------------------------------------ Liquid Capacity- --•----------------------gals. :.Priv-y:. ,, ,Distance from nearest wel}-------------------------------- ---_.-------:_,. Disfancee.from nearest building-ti_-.---------------------------------- El _-_________❑ Distance to nearest lot line--------------- ----- ---------- - -------- ---------- ------------ - ------------------------------ ----------- Remodeling and/or repairing (describe)---------- -----------------------------------------•------------------------------------------- -----� _-_------•----------------------------•-------•--------------------------------------------•----- ----------------------------------------------------- I C ____________________________________________ __________________________________________________________________________________________________________________________________________________________________ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, a rules nd regulations of the San Joaquin Local Health District. (Signed) =" _ — ------------- - --------------------------------------------------------- --------------------------- ---------(Owner and/or Contractor) . B -----•------------------------------------------------------------------------------------------------------(Title)---------�_�'� ----• ------------------------- �} (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F R EP RTMENT USE ONLY APPLICATION ACCEPTED - --------------------------------------- DATE------ - REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------ DATE------------------------------------------------------------ -. — --- BUILDINNGG PERMIT ISSUED-7 =______4r_:____-:-- ----------: _ DATE r. . Alterationsand/or recommendations---------------'�--•---------------------- •---------------._,...------------------------- -------_-_____-•----------•-------__-------------------------------• s 3- f - -} ..� �"-�------------------- ------------- _� ----- ----- - I - ------------------ --------------•-------- -------------------- ---.------•------------------------------- ---------- •- ------ ------------- ---------•-------------- ------------------------- I - ------- ----------= ---------- ---------------------------- ---- -- - ------------------------------ --------- FINALINSPECTION BY:------ - - -- ----------- -------------- Date_- --- �------------�- - ---------------------------------------------- SAN ------------------ - - -- -- ------SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cal;fornia Lodi, California Manteca, California - Tracy, California k M ES-9-2M 10-52 Revised W-2100