6409 - Laserfiche WebLink

Home Browse Search

r APPLICATION FOR SANITATION PERMIT Permit No. _.G_._..._-.�_..... (Complete in Duplicate) Date Issued ---- .� -1-' Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. _f4 -. ..CX....... . v�e ---- -----------------------------•---------------- JOB ADDRESS AND LOCATION----------------- -- --- ------------------------------ Phone-----'---- ---------•----------•---- Owner's Name-.""-_��- ------------ 3 Q.C� -- `e--------------------------- -------------------------•--------•----------••---------- � � ---- ---------- ----- Phone. Contractor's Name-"- "_-��`-f -t-�`- ----•- '---- - Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �----.- Number of bedrooms --2--. Number of baths I--- --- Lot size ------Z� 4----------- •----------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -,`�, ff. Adobe Hard an Character of soil to a depth of 3 feet: Sand F1 Gravel F1 Sandy Loam [:] Clay Loam Cla ❑ P E] Previous Application Made: Yes E] No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) –. Septic Tank: Distance from nearest weh---�"�.........Distance from foundation-----/0.._-----Material---------------------------_--_-------------------- No. of compartments-..--- __ Size---- ------�_k---------Liquid depth-------------------- --- - Capacity-----�Qo ------- I ' Disposal Field: Distance from nearest well -t---Distance from foundation---./-_1'_e."..-�-Distance to nearest lot line,._____ --..-- Len Length of each line-----_- --_.Width of trench._--. -------------------- (` av "v Number of lines------ --/------ j-)-(--- ---- g v ` Type of filter material-_J. R Depth of filter material------1�.-.......Total length------�------------------- " _U Seepage Pit: Distance to nearest well-.-14 d-_---- Distance from foundation---- a--_--_--Dista e to nearest lot Gne._--a------ - --------Deptn -'-ZV `A Number of pits-.-_."j.-----------Lining material----�.�--...6r--.Size: Diameter_.-- _ -"---_- '[\ -------------- Cesspool: Distance from nearest well---------------- Distance from foundation....------------- - Lining material---._-_---------------"-----g - Li uid Ca otic gals. ❑ Size; Diameter-------------------------- ----------Depth--------------------------------------------------- .-Distance -------------------- ------------------------ q Capacity Privy: Distance from nearest well---------------------------___----- ._Distance from nearest building-.-------------------------------------- Privy: Distance to nearest lot line -------------------'----- ' -------------------------------------"-------------------- Remodeling and/or repairing (describe):--------------------- ---------------- ----------•---------------------------------••-----•----• - ----- ------------------------------•--'- ----••---•---- ----------------•---- ---- --------- - - -- ---- -- I hereby certify that I have prepared hi olfca thti eon and San Johat the work Health beDis done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations - -.----(Owner and/or Contractor) (Signed }--.-- •--- -•-- -- --------------- BY: - - --------------------------------'--(Title}- --- --'---�---------------- -'-' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si e). FOR DEPARTMENT USE ONLY — ----- DATE--------------- � -------------- APPLICATION ACCEPTED BY-----------'--------------- - -------- --------- --- �` REVIEWED BY---------------- '--------' -------- -'--- - -'--------'-----'- ----------- --- - -------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------___------------------ -'------- -'------- DATE--------'--•-------------- --'------ ---'------------------ Alterations and/or recommen ations:-...---.- ------ --------_-------------------------- - ------------- -------------------------------------------------------- ---'---------------------------------------------- . // / -- �'---------------------------�9 FINAL INSPECTION BY:-------- '-'------. /-� Date---- ------- ------ SAN JOAQUIN LOCAL. HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tree California Stockton, California Lodi, California Manteca, California Y rs--a.—zt�n 145446 A7WO=D 1x54 _