6856 - Laserfiche WebLink

Home Browse Search

\X'l APPLICATION FOR SANITATION PERMIT Permit No. ._.(�-±�-'Xr (Complete in Duplicate) // • .�. Date issued .___.___��l._s�_ . _ .� pplica;-ion is hereby made to the San Joaquin Local Health District for a permit to construct and in tall thGe w_o/�rk her n described. This application is made in compliance with County Ordinance No. 549. j@�{- .S�`d� W. Ld InIta," V JOB ADDRESS A LOCATI N _s._{ie�G._ w--- _--_--�u�_. .. r--- _ l17 !_-oi ---- '�1-------------- Owner's Name---- {� F?l'1� �f -L E�_1h..-------- C� ----------------- ------- Phone`? -------------------------- ,g Address.------:[�11-Z---- -- -- --- ------- Contractor's Name--------------- - Phon Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailed Court ❑ M tel [❑ Other f—WNumber of living units: __`-� Number of bedrooms'_ Number of baths ____- Lo size '_ '_ / .'� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _30ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[.-- ardpan ❑ , Previous Application Made: Yes ❑ Noew Construction: Yes �la❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- - ---Distance from foundation__ S ___.__.__.Mat rrial__________________ __-__._________ _- _ fJa. of compartments___ _________....Size t�st -��rt�__.___Liquid depth_ O_r...........CapacitY__ _ _C?_ l Dis osal •eld: Distance from nearest well _ __-__Distance rom foundation__ __�r ____---------_Distance to nearest lot ane.__ -_._�__ p� Number of lines---- _ ��_ --.._.__Length of each line_130.�________________Width of trench__-�_L__��.._________---�j Type of filter material__. ,_______._Depth of filter material____IS_J1__-.Total length___ 0_*________________________� C Seepag�Pit: Distance to near st well...t4A?' �___Distanc fromrfoundation__/O....___.Distance to nearest lot line___________��M [� Number of pits.'_i................Lining material iS,!`_____.-_Size: Diameter._. _c�-.-._______De tn__- c ! P� pF 0` 2 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.__,_.___..___________._________ ❑ Size: Diameter----------------------------- --•---Depth---=-------------='---------- ------------- ------Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well.........._------------------------------------ _Distance from nearest building------------------------------ El Distance to-nearest lot line-------_----------.--------------------------------------------------------------- ' Remodeling and/or repairing (clescribe)--- ' -C'�AZZ&---------------------------------•------------------------------------- ------- --------------------------------------•---------------•------ ----------•----------------------------------------------------------------- ---------------------------------------------------------------------------- ----------------------------- ----------------------------------•------------------------------------------------------.....--------------•-=----------------------- ----------------------------------------------------- --- - ------- 4 I hereby c rtif that I h ve prep this app c +ion and that the work will be done in accordance with San Joaquin County ordinances, St ws, and les and r gulations f he San Joaquin Local Health District. � Q_ Co rector) (Signed)....----- -- - -- -- ----- ----------- --- - - By:--------•-----------•-•----------••------------------------------- --- --------•-- ------------(Title)- (Plot plan, showing size of lot, location of system in rale 'a to wells, building etc., can be prcedon reverse side). FOR bikPARTMENT USE ONLY l APPLICATION ACCEPTED BY ----------------------------------•------------------------ DATE-- ------ !� 1 . REVIEWEDBY---------------------------------------- ------------------------------------------------------------------------------. DATE------------------------------------------------------------ BUfLDINGPERMIT ISSUED----------------•----------•-- ----------------------------------- ---------------------------------- DATE----- ------------------------------------------------------- Alterationsand/or recommendations------------------- -------------------- -------------•-----------------•--•-•----------------•-•--------•-•------•---•------- -----•- -----------. ---------- - ••--------------•-----------------•-------------- ------------- --- - ------------------------------------------------•--•------------------- --------------------------------------------------------------1---------- -----•----•----------------------------------------------------•-----:---------------------------------------------------------- ------------------------- ---------------------------------------••---•------------------- ----------------•-------------- ---------------------------------•----- ---- ------------------------------ ----------------•------------•-•-•--------------------•------------------�V------------------- FINAL�lNSPECTION BY:---- Date----- ----- -------------------- 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 145446 A":WooO i2-54