4139 - Laserfiche WebLink

Home Browse Search

vv� APPLICATION FOR SANITATION PERMIT Permit No. _� ....L-._. (Complete in Duplicate) 7 /Date/ 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 N . 549. ,,> JOB ADDRESS AND LOCATION--- Z. / 7--- ------ --- ----------------------- --------- -- -- -------' Owner's Name-------------- +r--- * - -�''------------------------------------- Phone------------------------------------ Address---------------------------------- -- ------- --- - -- - ------------ Contractor's Name..... _ _y. Q_a-__ �1 _ `- /C• ? __ Phone_... _I6► Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___/__ Number of bedrooms , ._ Number of baths .J___. Lot size .___,'��,, '__ -_____.___._ Water Supply: Public system ❑ Community system ❑ Private epth to Water Tableoo l ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam ❑ y Loam E] Clay E] Adobe ardpan E]Previous Application Made: Yes E] No New Construction: Yes No ❑ 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_________________Distance from foundation--------------------Material_-______---____--_._-------__-------_-__-.---_-. [E--:]]4' o. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity-----------------------� Disposal 'Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-_____--------__- . Number of lines-----------------------------------Length of each line------------------------------Width of french.---_--_--._-______-__-_.---__---\�, Type of filter material-------------------------Depth of filter material--------------.--------Total length_______-_-____--__.-__-__------ V Seepage Pit- Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- ❑ X4 Number of pits----------------------Lining material---_-----------.--__--.Size: Diameter-------------.---------Depth-_-----------------.------------ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------.____._. Size: Diameter--------------------------------------De th----------------.--------.------ ----.--Liquid Capacity Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.-_---_--_----_-________ ❑ Distance to nearest lot line-------------------------------- ------- -- --------------------------------------- ------------------------------ ------------------ Remodeling and/or repairing (describe)------------------ --- -- - - _. --- ----- .. ......... ------ - ---- -- --------'_-.. --------------------------------------------------------- --- --- ------ -- -------- . --- --------------- -- .. --- ___:� ----- ------------------- I hereby certify that I have prepared this application and that the work will be d e in accordance with San Joaquin County ordinances, State laws, nd rules and gulat'ons of the an Joaquin Local ealth District. t (Signed)------. ` -- --------- -- i ---- ----(Ow /or ntractor) Title. sv E" ------�7�R ------------- (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 APPLICATION ACCEPTED BY DATE�------------------------------------------------------- REVIEWEDBY------------------------------- ---- ---------------------------------------------------------------------------------- DATE----- -- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ --------------- -------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------.------..------------------------.------------------------------. ------------------------------------------------------------------------------------------...................................----............................................................................................ -------------- ------------------------------------------------- Ynn �r- FINAL INSPECTION BY------------------------------------------'�!'' -'----- Date--------------------5- ----`�--_- ------..------------------------ 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 ES-9-2M 10-52 Revised W-2100