4994 - Laserfiche WebLink

Home Browse Search

n ! APPLICATION FOR SANITATION PERMIT Permit V No. (Complete in Duplicate) Date Issued. _.. _ Applica-ion is hereby made to the San Joaquin Local Health District for a permit to construct an install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT ON.._........... ....... -_ Owner's Name ------------ Phone: . --------••-•-•-••-•--- Address----------------------- -•••• ---------- ----------------------- -- -•-••••- Contractor's Name !1 Q Y4, 'G Phone �_��__-� 60 - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ,1--'_;�Communify umber of bedrooms .-/_. Number of baths ./__ Lot size _.._....7�� gle................ Water Supply: Public system system ❑ Private ❑ Depth to Water Ttable -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ 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.) Septic Tank:y-_ Distance from nearest well-----------------Distance from foundation--------------------Material____-_--_._---_-._--_-_______-••----.___-_-____: No, of compartments------ _-.-------------Size ._.._._ .___..._Liquid depth.......... ---------Capacity s� i �s Disposal�Fiel/ Distance from nearest well f ------.Distance from foundation_._�.�.._.__.Distance to nearest lot line.-/ ______ -- Number of lines----- Length of each line------ ._Q__�r Width of trench...., .___7_______-_-._•_-•___ Type of filter material- �__ _ _J_�_ Depth of filter material._t�-----------------Total length---------Z. •_•--_-____ • /r!� Distance fe to nearest lot lii�ne--�- � Seepage Pit: Distance to nearest well._� -----------Distance fro*Tation.__ .____ '� N Number of pits_--a'Z`--.-_-Lining material._ _ i e: Diameter_--- .... _.__Depth-------�{_—'`�______------------- Cesspool: Distance from nearest well_______________•-Diltance frotion -. .- Lining material------------------------------------- El _._ ---_-- -__-_--_-__-__•.__•._-- ❑ Size: Diameter------------------------------------_D+th---------------------------------------------------Liquid Capacity- -- gals Privy: Distance from nearest well------------------------,- ______ -..__---__ Distance from nearest building------------------------------------------ Distance __.:__, ____ -------_.-_-__--_-_.Distance to nearest lot line -- - ---- ---- ----- -------- - ----- ? Remodeling and/or repairing (describe).-------------- 1� , `2R �� G�..A.... . .....................................••-••••------•••••---•-•--•-•----•••••-- ..•--•• ....... ----------------------------------------------------- 21e --- •-------------•------- ----- - _ - ----- 7 • . .......... ---- .----- -- -----------••----------------------- --------------•--•-----------------------------------------------------------------------------•-------------------•-------------------•---•------------------------------------------- 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, nd rules and re ulations of the S Joaquin Local Health District.' 41 (Signed) --- •--••---• __r ---- ..-- (OW and/ Contractor) By:-------------E - (Title) (:` ----rac- (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc., can bs placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- a1L�fDATE � �r REVIEWEDBY------------------------------------------------------ i------------------------------------ DATE--------------••-•- BUILDING PERMIT ISSUED-------.-..-F-----L-'---r-L.Z ---- ----- DAT ------ --- -----------v ' ! �- ak. rCAlt tis and/or d / h � W . ------- /T ____.. /T-----ab. P. C ^0 1 ..�s_ t_ -------•- -------------o •-••••-•-------•-•-•---••-•----•-•-•------------------•------------------------------------------•--•----•-.....•--•-•-•-----••-•......---......•---•---•••••---•-••-------••-...•••--------......_--------•-----•------•-- --------•----------------------------------------- ............... FINAL INSPECTION BY------------ ------------------------------------------------ Date---------------------------------------------------------------------- ......... 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 ; Revised W-2100