2051 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No.a_iQ- r---- lDuplicate)` f (Compete in upcae) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i tall the work herein de cribsd. This application is made in compliance with County Ordinance No. 5 rrJ � � JOB ADDRESS AND — ' J Owner's Na — '—� = _� � one_ -------- Ph — U �_. -_� ._ - --------- Address------ -------- t- -- - � --- -�� ----- -- -- --GG------- ------------------------ Phone—, �T l- -------------- Contractor s Name---------- - -�--- ,rte---------------- ---- ------------ ----------------- Installation will serve: Residence ❑ Apartment House ❑ Commercials Trailer Court ❑ Motel Ej Other ❑ Number of living units: _ - Number of bedrooms _!Number of baths Lot size -- _ _____ _____ _______ ___ __,---------------- Water Supply: Public system F1Community system El Private. ]" Depth to Water Table ______-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑. Adobe Hardpan ❑ Previous Application Made: Yes ❑ NoA�' New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j ____- .Material____ ; ,�- Septic Tank: Distance from nearest well__ TJ_____Distance from foundation___) � ��' �--- - ------------ No. of compartments_____- _____r__---Size_ �___*Aiquid depth_ X/�______Capacity__ _ �J'____ O �`t I Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines Length of each.line------------------------------Width of frencl�---------------------------------- Type of filter material-------------------------Depth of filter material---------------------Total length-------------------------------------- - �y Seepa a Pit: Distance to nearest well-.-__---- ____Distance froni I�fo,�i�dation_-__/ _____.Distance to nearest lot line___ __ ______ eFNumber of pits--------/------_- Lining materia��__�--L2-__Size: Diameter---_�----------------Depth---- - ---------------- Distance from nearest well________________Distance from foundation--------------------Lining material __________-_--___________-________ 0 Size: Diameter-------------------------------------Depth------------------------ •--------Liquid Capacity-----------------------------gal s. "~ "" Distance from nearest buildin ;J Privy: Distancefrom nearest well -----'-------------- 9 ❑ Distance to`nearest,lot line____________ _ Rem d (de Abe}eg and or air • r ' �. = - ------------ ------- ------------ � d�' - ----------------- -------------------------------------------- I hereb certi that I have re pared this application and that the work will be done i r ante with San Joaquin County -- y p pP Yk the San Joaquin Local Health 'Distri ordinances, State s, and u es end regulations of (Signed)------------- -- p / 1! ----- -------------------------------------------- (Owner and/or Con+rat+or� �meyq/// '"y By:------------------- t Y'---C_-------- ---- --��------------------------------- -------:-(Title) r= r Plo+ plan, showing size of lo+ ocati n of system n relation to wells, buildings, etc., can be placed on reverse FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- -------------------------------------------------------------------------- DATE__ ----------------------------------------------- ► REVIEWED BY---------------------------- -- DATE. jr`\--------------------------------------------- BUILDINGPERMIT ISSUED--------------------------- ------------------------------------------------------- DATE---=------ Aer tions: ----------------------•------------------------•---------------------------------------- oro x+�+ --------- ----------------------------------------------___#-F____________._.--------------------------------- _________________________________________________________________.__-___-_-_ _____________________________________ ____________________________________________________________________________________________ � i . 1 //J (f---------------- FINAL INSPECTION BY---------------!/_------------------ Date �C_..f 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 8-51 Revised W-2100