5567 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMI ' '�� Permit No. ------------ (Complete in Duplicate) ' Date Issued -1 Applical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the Work hereinn`.de tribe-d.� x-, #_ This application is made in co m fence with County Ordinance No. 549. - JOB ADDRESS AND LOCATION.. *` '------ -------- }- -•--------- ' (9 .2-7— I6 � ---------- -------------------•------------- Owner's Name L-•---= ----------------•--- - --------------- - --------------- - ------- ---------------- Phone__z_4!1-: Address----------_-------- 0A � 7-Cc_' "�7;r_ ----------- �! Contractor's Name---__--_-.-, E�, f'' -- .-_____ • ------•--------- ---------- --------------- --------------- - -------------------- Phone Installation will serve: Residence El"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other I] Number of living units: _-!--_ Number of bedrooms -_3- Number of baths .... Lot size .----6 __.�;-_-_- -`-------------------------- Water ____________________ _Water Supply: Public system ❑ Community system ❑ Private ©-'Depth to Water Table -------- ft- - T Character of soil to a depth of 3 feet: Sand 2�Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ `v Previous Application Made: Yes No 0 pP ❑ New Construction: Yes [� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C D 1+4. a c Septic ink: Distance from nearesr welL__.S�__--.---Drstance fro foundation-_1-�?_-_---._.Material-`�-�____________________tt____ No- of compartments_._ ----_-_---Size--_?/ , Liquid depth_-------�--_--__--.Ca Capacity------ —[7 p Y � Disposal eld: Distance from nearest well....- ----f------Distance from foundation____/_-- Distance to nearest lot line-----_ •._- Number of lines ---- .---------Length'of each line-----/2--,0------------ of trench.-_-�-0_.__-___ /r r Type of filter material__ - _ rf-_-Depth of filter material___---eJ -- g Yp Total length ---- - ------ - Seepage Pit: Distance to nearest well_--------------------Distance from foundation-------------------.Distance to nearest lot line------- ------ ( _ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------. _ - --Depth------------ ------------------- Cesspool: Distance from nearest well_----------------Distance from foundation--------------------Lining material------------------------------ ❑ Size: -- — Diameter--------------------------------•-----Depth_----�-------_---�--.---_---.-,-_---_---T---. _L i ui_d_CTa azci-tY----------------------------gals. Distance from nearest well------------- -------- --------------------------Distance , from nearest building-----__---._.__-_---- 171 Distance to nearest lot line-- -------------_:- Remodeling and/or repairing (describe):-------------- ---------- ----------------------------------------------------------------------- ere y cert' y 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 Disfri (Signed)-------------------------- `--J----A10---------U- a? ------- .•��---------------- r .(Ocaner 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 APPLICATION ACCEPTED BY �DDA�TTE __ ----------------------- ------ - ---- ------- -------- -- -------�------ -------- ED BY ---- BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------- DATE----------------- --------------------- ------------------------------------------ - ------- DATE-.--- Alterations and/or recommendations:--------------------------------_.__ ------- ---------------------------------------- ------•--------•---------------------------•--------------•-------- -----------•- ------------------------- ---------------- ------ -- - --------- ------------ ----------- ---- - ----------------- - dFINAL INSPECTION --------- �. -- --- Date---------/ C7 SAN JOAQUIN LOCA HEALTH DISTRICT 00 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 W-2100