2881 - Laserfiche WebLink

Home Browse Search

.ui-r APPLICATION FOR SANITATION PERMIT Per i�(o. (Complete in Duplicate) Date Issued 8 = �2 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: rr Q JOB ADDRESS AND LOCATION...-.L. : Owner's Name---------- -. A,-��: 1 Gt.0 . S-- -------- --- - -- -- ----- Phone lq_2l Address----------------------- -----------:.........."'�' `t--- - - Contractor's Name-------- •--------------- y a ` �" '�?`?+ Phone 7=910. X7---- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units .f.... Number of bedrooms -1-- Number of baths . _._. Lot size .��.-� :_ •_::1 _ .-77...... Water Supply: Public system ❑ Community system ❑ Privat� Depth to Water Tablg„ .. ft. Character of soil to a depth of 3 feet: Sand Fj Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe ,Hardpan ❑ N; Previous Application Made: Yes [-] No'� New Construction: Yes E] No E] ( � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well0l9'7 Distance from No. of compartments__-1-------_--------Size �` .. 'Liquid depth_�?_a-___._.Capacity .__..__ � -- f/ Disposal Field: Distance from nearest well-, 70 Distance rom undatio ___ ..._______Distance to nearest lot iine.�-. ..... Number of lines._ , -..__ _ Length of each fine___..Q!: Width of trench A-Y... !!LL u�` Type of filter material.__Ll3y-, (:_Depth of filter material----/ig'o-.......Total length'j.Q -__ ....... Seepage Pit: Distance to nearest well-100--------Distance fps !f undation.:, S .--..Distance to nearest lot line Number of pits ...............Lining material_._____ . '_G _-Size: Diameter-_-s�0----- Depth----- . ------------------- ACesspooL Distance from nearesf_well.................Distance from foundation--;_-.----_--:_.,:Lining material---,------_------------------------ El -.-,..__ .__---_-: ------ ❑ Size: Diameter.... --•----- ------------------Depth----- --------- ----- -------•--.-Liquid Capacity...................... - gals, Privy: Distance from nearest well_________ _________ :__-.-..Distance from nearest building..--_:_ .-_---:_:,..--•-_M __.---_-. ❑ 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 done in accordance with San Joaquin County ordinances, State laws, an es and regulations of t e San Joaq ' ealth District. (Signed).: - ---- --------- = ti - .... Q ( 'wContractor) �rrlr�� • By----------_-------= -- - -- -- ----- ---- ---------------------------------------------------------------(Tale) 4'ry . (Plot plan, showing z of lot, locatio of system in relation to wells, buildings, etc., can be pl ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ES- - DAT ._ .... ._--• REVIEWED BY------------- ----- - DATE - BUILDING PERMIT ISSUED----------------------------------- Alterations and/or recommendations: --•--•- ---- -- --------- -------- -------- -- - .. . ------------ --- ----------------- � l FINAL INSPECTION BY:------------�'f,!(/_ ------------------ Date_. - - '-: ----------- _a,e---------- SAN ----- --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 8-51 Revised W-2100