10984 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. j.d.�.�..,.. (Complete in Duplicate) G l G� _\ Date Issued __ .......... � _/. � Y ,A))*Thpsappl application is hereby by mad compliance Joaquin h Countyal Health District for a permit to constru t and install the work herein described. JOB ADDRESS AND LO TIO f_-_�Q '--------------------------------------------------------------- Owner's Name----------- jsi_.L.. ------------------ Phone------------------------------------ - ---- Address ----------- ------ � �. r Contractor's Name---- --------------- Installation ------------- - Phone Installation will serve: Residence Apartment;HouseCommercial E] Trailer Court ❑ Motel ❑ Other E]Number of living units: ___�___ Number of bedrooms _ _-__ Number of baths __!-_. Lot size _ -___A__Icaz ___.__________________ Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table !�� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe 0"'Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ (�V TYPE OF INSTALLATION AND SPECIFICATIONS:; (No septic tank or`cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest we�lj_ -____.Distanc�f om foundation._` :...........Magi 1___ _ ........ . ............. (�' No. of compartments____Y ____`__Size_ .X--- ----------Liquid dept__,;/p-__.________Capacity... Disposal ield: Distance from nearest well. ,. Distance from foundation ___ _._____Distance to nearest of I,�� . ____-- - [L]� Number of lines........��.._'____-____- ____ ength of each line__��______f�-, .Width of trench___�'�`__�_________________ Type of filter material_, _ -- -Depth of filter material---- -- -------Total length.--- - ---------------------- Seepage Pit: Distance to nearest well_Ile�______Distance f m ,fo�uu ation__ _---Distancee to nearest lot line--%5_ ______- Number of pits_!__ _� �,Llning material'__ ,�i �c _ ___Size. Diameter-_-_ __ _ _-____Depth_-_z _____________-._- Cesspo Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------.___._. ❑ Size: Diameter----------------------------- --------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__-____________________-__.------_-----_. ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe) t /l`��,1�,, -•---••---------•- -------------- ---•-----------•--•---•---- - - ---- - -- - - - ----- , � -��'-----�£ "--•-•-------------------------•-•-------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------•---------------- 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. Si ned `— ( 9 )-------------- ( r�eflwr Contractor) By: ----------------------------------------(Title)-------- --- ------ (Plot plan, showing size of lot, Iota ' of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ------- =--------------------------------------------- DATE------------------------ - REVIEWED BY - --- ------- DATE f BUILDING PERMIT ISSUED........................ ---------------------------------------------- DATE----- l - Alterations and/or recommendations:________. . --- - ---------- " 51 4 /' 2--� ._ _ �" ___ .... --------------------- 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 1.57 F.P.CO.