14979 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 2 ----------------------------------------------1111-- ---- X1 APPLICATION FOR SANITATION PERMIT Permit No. ..1..... ...7. ---------------------------------------------------1111-- (Complete in Duplicate) Date Issued .:...:....... --------------------- This Permit Expires 1 Year From 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 No. 549. 1�1 JOB ADDRESS AND OCATION.._C /L� f , -------------------- --- -- Owner's Name " -•-.....�g---•••---•----M-------------------------r y--- ----------------------------------------•--- Phone.................................... Address '-• • -- --•---- -y'--- ' ` L._ 0. Contractor's Name.. •-• --`---1111-`-_-� ---------------------------------- ---------------•---•---- Phone................................... Installation will serve: Residence ❑ Apartme t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...1... Number of bedrooms -_umber of baths .1..... Lot size •.... _._/'}•--:.� �Aa.l•...,_......... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .24ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayAdobe❑ Hardpan ❑ ___ Previous Application Made: (If yes,date_________ ________) No New Construction: Ye �HA/VA: Yes ❑ No 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septict-T Distance from nearest well..O-Pg.Distance from foundation.....)#�__-.Material................................................. No. of compartments--------------------------Size--------------------------------Liquid depth..........................Capacity-......... .....-. - Dis o al Fie�d. Distance from nearest well-A0.0.Distance from foun 'tf��__ ..��Fance to near- Number of lines.........I--__-_-_ _. -.Length of each line _..__S.__f._ ._.. Width of trent .......1` g '' ��tt ¢¢ �i+r-•-1.111----•--- vfi;�� Type of filter material.J�..�T0'�Depth of filter mat rit,�Q_____ _________?otal length______ __�. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest Jot line................. ❑ Number of pits......................Lining material.......................Size: Diameter........................Depth................................. Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material....................._..__....•...... ❑ Size: Diameter-----------•--------------------------Depth----------------------------------------------------Liquid Capacity............................ . Privy: Distance from nearest well ________________________________________---._Distance from nearest building_______._..__.______.__.._.._.__.....__... G. ❑ Distance to nearest lot line--------------------------------------.................................................. Remodelingand/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 ruland regulations of the San Joaquin Local Health District. (Signed) � ------------------------•---•--••---------------••--------..._..-•--------------(Owner and/or Contractor) By:........ ........... • .......................................................................................................(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 APPLICATIONACCEPTED BY-------------------------------- -------------------------------------------------------------•-• DATE-----------•----•------------------------------------------- REVIEWEDBY------------------------------------------------------------------ DATE........ ------------------•--•------- BUILDING PERMIT ISSUED......................................... - - - -. DATE - ! t ° Alterationsand/or recommendations:..............----------- --------------------- ---------------------------------------------------------------•-------•-----------...............---•--..._.. ....•.................................................................-----_.............................. -•------------------------•....------------------•---•--••-----------••-----------------••----•- ••----•-•---. ----------.-----------------------------------------------•---------------------------------------------..._....------------------------......-----------------._.....--------•------•----------------•-••----•---------••---- FINAL INSPECTION BY-------- --------- ----------- Date----------- / -i. -------_----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.89 ZM 6-61 ATLAS