2390 - Laserfiche WebLink

Home Browse Search

r W APPLICATION FOR SANITATION PERMIT Permit No. -- ____-r�,�_�'� (Complete in Duplicate) Date Issued - F Application is kereby 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. JOBADDRESS AND LOCATION-------------------1-541-5--S-•---P-Inclao-t------------------------------------------------------------------------------------------------------ Owner's Name--------------- -- kf-,V-s--------------------------------------------------------------------------------------------------- ------ Phone-----3-"x_81-7-------------- Address------------------------aarLI-e----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name--------------•--Ve:leia--------------------------------------------------------------------------------------------------------- ---- Phone-----3----3-9-55----------•--- ' Installation will serve: Residence El Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---2-- Number of bedrooms __2__ Number of baths ----2---- Lot size .-_---5QX7-25____________________________________ Water Supply: Public system 0 Community system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: Yes ❑ No,-EJ New Construction: Yes ❑ No Z] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material_______________-______________-_____________- exisCLTIpgNo. of compartments-----------------------__Size______________------------------Liquid depth--------------------------Capacity--------------------- _ Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-----__-.--_._._- exist❑ g Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-_____________:____.__Total length___________________________—.;------ Seepage Pit: Distance to nearest well-__-___--------------Distance from foundation_---- _�______.Distance to nearest lot line___2E�___ 36'• n Number of p'sts----------�.---------Lining material------ Diameter_-_•- -----------------Dept h--------2-5-„-----_-----__-.- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________________________________- Size: Diameter--------------------------------------Depth--------------------------- -----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_____________________________._-_------__. } ❑ Distance to nearest lot line--------- ----'--------------------------------------------------------------------•--------------------------------------------------------- Remodeling and/or repairing (describe) l.ia` 0---lew---ve-rl-lD-= l---dr-a u----------------------------------------------------------------- ---------------------------------------------------------------• ----------------------------------------------------.------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- -------------------------------------------------•------------------------------------------------------ ------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. 1 (Signed)-------l l.t a---- ----------------------- - (Owner and/or Contractor) S . P 'r_�= ,1 �° ^' _Q -`--------------------------- (Title)------------owner-'.. . Y:----------------- (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---- ----------------------- - ------- ---------------------------------------------------------- DATE- REVIEWED BY--------------------------------------- ----------- - -------------------------------------------------------------------- DATE-------- ,1 �•--------------------------------------------------------------------------------- BUILDINGPERMIT ISSUED---------- -- ---- --------------------------------------------------------------------- DATE--------------------- ------------------------------------•- Aiterationsand/or recommendations------------------ ------------------------------t.---------- -------------------------------------------------------''--------------------------------------- ----------------------------------• d , ., ------------------------------------------------------- $: �} L '1�/'-� -f-- ---- "-----V---- ------------------------•--------- - ------------------------------ ------------------- ---------------------------------------------------- -------------------------•------------------------------------I---------------------------------- --------------------------------------------------------------------- ------------------------------------------------- ------•--------------------------------------------------------------------------------------------------------------------------------------------•------•----------------------------------------------------------------- FINAL INSPECTION BY__________________ _ -------------------------------- Date-------- --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, Calrffornia Tracy, California ES-9-2M 8-51 Revised W-2100