99-64 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7 _ Date Issued __._./ S_ _ Application is hereby made to the San Joaquin Local Healfh 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 LOCATION- 5� Q. Owner's Name-------- 11. ---••---------- - � ----------------------------------------------- ----- Phone. . ' p Address �j2 ..j..----- �.. Contractor's Name _- �� ------..!`•--'- ...... ---- Phone!!_.e ----- � Installation will serve: Residence 040"A"partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �� Number of living units: __/__ Number of bedrooms __ _- _-__Number of baths Lot size .__a3-_v... __________ Water Supply: Public system (�mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Na New Construction-. Yes ❑ No FHA/VA:Yes ❑ No TYPE,P_F INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is avai[a6le within 200 feet.) p 1 Tank: ('Distance from nearest weli-----------------Distance from foundation----------------____Material-___-_-----_-_..._.- No. of compartments------------ ------l-!------Size--------------------------------Liquid depth-------------- -----------Capacity------------------------- - -is sal Fiel r" istance from nearest well_jq_09i&_Distance from foundation---!1- r --------Distance to nearest lot ine_-�__-.__ umber of lines__ ____ _ ___ _ _ __Length of each line-._ `l?- ---------Width of trench__,Z_��------------_------ „ Type of filter material- Depth of filter material___ -��------Total length__ aQ_.--____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation___________-_•--_--.Distance to nearest lot line------_---------- r ❑ Number of pits----------------------Lining material-----------------------Size. Diameter-----------------------Depth--------------------------------- ck� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-.___-_______---._-_-________-____. ❑ Size: Diameter------------------------------- ------Depth--------------------- -------------- --------------Liquid Capacity----------------------------gals. �n Privy: Distance from nearest well------_-----------------------------------------Distance from nearest building--------------------------------------- �} ❑ Distance to nearest lot line : Remodeling p 'i ` g (descrrbeJ:'_L'_ ._._ _ _ ------------- _ -- ----- - --_---' -------------- ---- - _ ---------------------------- -------------------------------• ---------------- --------------------------- y I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State aws, and rules and regulations of the San Joaquin Loca Ith District. _ Y (Signed)---I _ a �{aws )� -- -- -- ------- --- ------------------- Contractor By--------------- -----------------------•-------------------------------- ------- ----------- --------------------------------------------------------------- (Plot plan, showing size of lot, location of system in a a#ion to wells, buildings, a c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y --------------------------------- ------------------------ ----------•---- DATE- REVIEWED REV[EWED BY DATE_' ----------------- BUILDING PERMIT ISSUED---------- `- --------------------------------------------------------------------------------- DATE----- Alterations and/or recommendations--------------------------------------- • ---------------------------------------------------------•---------------------------------------- FINAL INSPECTION BY:..-- _,_.__._ ---- -------- - ---r- g--------- Date-__7-16 -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North sC" Street Stockton, California Lotti, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 F.P,CO. wl—'