4048 - Laserfiche WebLink

Home Browse Search

. 5 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicafe) Date Issued - - \-9 I 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. 54.9. JOB ADDRESS AND LOCATION.. / -•--- �� vrQ.r. Owner's Name--------------------------- ---------------------------------- ---------------- Phone---------•---------------------•---- ---- -- - Address------------------------- - ' ------------------/f'.- r . d/ 42-4a------ r-. ---------•-------------- Contractor's Name---------------------------------- --•---------------------------------------------------------------------------------------- ---------- Phone...-------------------------------- Installation will serve: Residence' 10 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / Number of living units: - ----- Number of bedrooms /___ Number of baths _ZLot size ------ ----------------- Wafer "'� Q C/Y►'P9 �r Water Supply: Public system'[] Community system ❑ Private © Depth to Wafter Table ________ ft. Character of soil to a depth of 3 .eef: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application.Made: Yes 1] .No ® New Construction: Yes ❑ No ❑ TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool I permitted if public sewer is available within 200 feet.) J Septic Tank: Distance from nearest well---51!9-------Distance f Anda-on--- ------.Matel____ �¢_______________ ® No. of compa4ments----------2------------Size--- ---X--�- __Liquid depth-----�---------------Capacity--- Disposal -- � J-----� Dis osal Field: Distance fro nearest well--.A?-) from foundation_ _ s• p � ��'"'!`*'��_.Distance to nearest lot lile____� __ 14 Number of lines-=�.----------1---- ------- -----Length of each line--,-----� -.-----------.Width of trench------ -------___---_.-- - Type of filter mafierial___5; Depfhiof filter material_______f�l!--__-_Total length__--_-�j-Q____________._________._� Seepage Pit: Distance to neares0well----------------------Distance from foundation--------.----------Distance to nearest lot line_______-_____---_ ❑ Number of pits--'------- ---------Lining material-----------------------size: Diameter-----------------------.Depth------------------------------- -' om riBarest \�arest Distance from foundation-------------------_Lining material------------------------------------- CessP❑ooS: S�zea D amnce leter_n \ _----------Depth-------------------------------------- -------------Liquid Capacity----------------------------gals, it Privy: Distance-krom•,naarest well_--.. __.____-______________________________Distance from nearest building------------------------.-------------- ._. ❑ Distance to nearest lot line-------- ------------------------ --------------•-------------------------------------------------------r-------------------............. •--------------•-••-------------------------------- ------------------------ --•------------------------ .. Remodeling and/or re�airilng (describe):____--a__________________ __________________ ---------------------------------------# -----------1--------- --------------- j--------------�------------------------------------------------------------------------- -------------------------------------------- ------------------•--•-------- -- l------- ---------K-•------------------- ----- -----•----------------------• ----•-- .. I hereby certify f4at 1 have prepared this applicati,an and that the work will be done in accordance with San Joaquin County ordinances, State laws,and r6i6s and-regulations of`ffie'San Joaquin cal Health District. ! (Signed) (r, ---- -- I---------------------------------------- ---(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). E ). 211 DEPARTMENT USE ONLY :. APPLICATION ACCEPTED BY---- ---F-- - - - - ' --- ---------------------------------------------- ------------- DATE-------. --5 ---,-�- --------------------------- REVIEWEDBY--------------------------------- ------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------- --------------------------------------------------------- DATE-------------------------------------•------------------- Alterationsand/or recommendations:------------------ --- ---------------•-----------•------------------------------------------------------------------------------------------------------------ -------------------•------------------------------------------------------------------------------- - --------------- -----------------------•------------------------------------------------------------------------------- k -------- --------------------------------------------------- ---------- -----•------------------------------------------------------------------------------- --•----------------------------------------------------------- t ---------------- ----- ----- ----- --------------------- --------------------- -------•-------•-----------------------------•------•--------------------------------- FINALINSPECTION BY------------ - --�- ------------ ------------ Date------------------ ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M 0-52 Revised W-2100