8029 - Laserfiche WebLink

Home Browse Search

r- _ APPLICATION FOR SANITATION PERMIT Permit No. _ _"_L .. (Complete in Duplicate) Date Issued .y__`I... — 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 Ordinance No. 549. JOB ADDRESS AND L-OAC-+ATION.. Q � " !r --------•------- Owner's Name---- Y 4 �-------- _ ! /-�� 1 Phone Address------------•---------------•------- - �� = Contractor's Name-------------------- eI-V`rr-eI ----•------------------------------------------------ Phone................................... Installation will serve: Residence j8'''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-. Number of bedrooms . Number of baths _4_ Lot size •__. e___r�.....Ile...................... Water Supply: Public system [`Community system ❑ Private ❑ Depth to Water Table "ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P"ardpan ❑ 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.) epti J,ank: Distance from nearest well--_--.._.-_-__.-Distance from foundation--------------------Material__--__--_ ................................ No. of compartments------------------ -------Size------•------------------------Liquid depth.------------------------.Capacity----------------------- Dispo I Field: Distance from nearest well--------------._Distance from foundation--------------------Distance to nearest lot line................. Number of lines---------------------.-------------Length of each line..............................Width of trench--_-__-_-_-.__--__---.----__•__-_-_ Type of filter material-------------------------Depth of filter material-----------------------Total length.......................................... Seepage Pit: Distance to nearest well leO -------- f Distance fro foun ation_�� -------Dist nce to nearest lot line--- Number of pits-----.`------------Lining material0G'0� ize: Diameter_ "`._.._.Depth__--- ............ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.__------___-.----_- -,.r Size: Diameter--------------------------------------Depth- --_--. -. Liquid Capacity gals. Privy: Distance from nearest well ------------------------Distance from nearest building-------................................... O ❑ 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, and rules and regulations of the San Joaquin Local Health District. Signed) 2-1110",........ r ..__Owner and/or Contractor ( / ) BY: l �� %� ----------------------- ------(Title)-...... ` (Plot plan, showing size of lot, locat' of ystem in relation to wells, buildings, etc., can be placed on reverse sig e). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------- ------- --------------------•-----•--•----•-----•... ------ DATE---------�--------------------------------- ---- REVIEWEDBY----------------------------------------------- ----------------------------------------------------------------------- DATE--------•--- - . BUILDING PERMIT ISSUED------------------- _ DATE------------- Alterations and/or recommendations:---...... ............. .-.......:_.._._. ._. _...... ...;_.__...__. ----------------------------------------------- ....._C.._ __ _ -------------------------------------------------------------- ...._..._..__._._.__.-._......__.._...._.__..___._..__......._...... ..._.._ ......... .... - -••__------ -- -/ _.___._. _fes'___... ..... .. .. ................................................................_..____.._.... FINAL INSPECTION BY:- �--- ----- Date..._: _- 1....� c '+� i 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 145446 ATWDDD 12-S4