9717 - Laserfiche WebLink

Home Browse Search

5`6 APPLICATION FOR7 SANITATION PERMIT Permit No.9 .--�7� 'x (Complete in Duplicate) Date Issued --- _.-_-- Applic&ion is hereby 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 Count Ordinance No. 549. JOB ADDRESS AND LOCATI N..--_1_ �__ Z_ - - --- --------- . ------- Owner's Name-. -------••- ----------- - -/— Address j. ��JJ ---�------ �-------------------------------- Phone--------•----------- 1 Address -------------- --------------•------------------•--------- -------------•-----------------------------•------------- - /---••---------._... Contractor's Name,2_ , -- „------------------- Phone_- 3 6 ---- --- ------- Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _I---- Number of bedrooms _�- Number of baths A---- Lot size _-�Y`__'�_:Y�w + i - - - ---------------------- Water Supply: Public system ElCommunity system ElPrivate 5 'Depth to Water Table Z-5_-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ' Previous Application Made: Yes [❑ No E3'_' New Construction: Yes Q"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .Septic Ta k: Distance from nearest well------------------Distance from foundation--------------------Material----------- No. of compartments .---___---_-..---.___ --------- ---.Size-----•--------------------- ---Liquid depth----------------------.--.Capacity------------- --------- A�ospld: Distance from nearest well................ Distance from foundation_-_--------__-----.Distance to nearest lot line--_--_------_---- Number of lines---------------------------- ------ _ Length of each line------------------------------Width of french Type of filter material-------------------------Depth of filter material----------.------------Total length---._-_--.-----------_---- Seepage Pit: Distance to nearest weli-._.l -_.:t'__---Distanc�f�roAm foundation-- f4t.(t-._.Di ante to nearest lot line--!!;)_�______ Number of pits...-�r-.-.-_------_Lining material.,__--_----Size: Diameter-_..- `,.? d,De to �Q 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------------------------------------------------- F ------------------ Re odeling and or repairing describe)----------------------__ -'Z- -f1-.11`R_ - -- - ------ - - „� ll� T �" y k _,; ---- ---------- - _. ,;;r; : ;;; ---- _ 4 -- ---------------------------------- - - --- - - - - - ------------------------- - - 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. s (Signed --------------- (Owner and/or Contracto"r) ------- Tale -- - 7_ _ ' ( � } ----- (Plot plan. showing siz 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-------- -- -- --------- ----- - ----------------- ,. -------- I WED BY---- --•-------------- --------------- ---�---- ---- DATE---- -- ------- --•-- - ------------------- ------------------------------------------ DIN PERMIT ISSUED ------ --- -.-. - - - -------- ---------------- Alterations and/or recommendations----------------- -- .`C ------- •------- •------•------••------•----•------ ---•--------- ----------------------------------- ----- -------------------------------------- ------------------------------------------------------------------------------------------------- --------------------------------•--•----------------------------------- d FINAL INSPECTION BY: � . --------------- ---------•---------------• Date-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 grwaoo f