4212 - Laserfiche WebLink

Home Browse Search

APPLICATION, 1 ON FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Y—ALI-1 Date Issuedy ?_3 Application is here made to the San Joaquin Local Health District Qq� re—re �-- Zp This a plicatio is made in compliance with County Ordinance Noc544r a�1t to construct and mstall`the work herein described. ©-gr, a,�7 ,�.,4�,�.t /,,3.0 111141 y JOB ADDRESS AND LOCATION_----- Owner's Name_ - �..-.rl X�_GiL�------------------ Phone------------------------------------ ---------------------------------------------------------------------------------------- -------------------------------------------------- Contractor's Name__________________ ----- ----------------------------------------------- __ - ------------- ----------------- ------- --• ----- --------------- Phone-------------- -------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court E] Motel El Other Number of living units: _ � __-____ Number of bedrooms ____---- Number of baths -------- Lot size Water Supply: Public system -- ------ Y� y ❑ Community•-system ❑ Private ® Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ 'Gravel E] Sandy Loam E] Clay Loam E] Clay [I Adobe,® Hardpan L3Previous Application Made: Yes ❑ No EK Newtonstruction: 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 well__-57�9_t_--Distance from foun tion___ -__.Mat dial__ SCI Cl9A4 -------------- O 14 No. of compartments-------- +-- --- -Size-_-�X ~_x Liquid depth__- - - -- -----------Capacity--1,>--D d-.F Disposal Field: Distance from nearest welli ->' Distance from foundation____ —� �d___-__.Distance to nearest lot line------ Number of lines___________._ _ ---Length of each line________ _ r g �s�_ ii Width of trench- Type Type of filter material---.�_ - ------- .Depth of filter maferial----4?-----------Total length-------- ---------------1 Pit: Distance to nearest well._.__.________ -------Distance from foundation______________----.Distance to nearest lot line_______________-_ ❑ Number of pits_---------------------Lining material--------------------- Size: Diameter_-____-___- - -- --------Depth--------------------------------- El ------- --------- ------ - Cesspool: Distance from nearest well-----------------Distance from foundation_____._-______----.Lining material-_.-___________- ----_---- ❑ Size: Diameter___---___ __ ---- ------ ------- eptly------------- -------- - - - liquid Capacity - gals ----- rivy: Distance from nearest well-_.-!_:__a__ ---------------------Distance from nearest building ---------- ❑ Distance to nearest lot line n_------ ---------------- 9 ----------------- •-------------•------- ------------------------- ----------------- ------ Remodeling an /or reps ing ( scribe)-------------------- , _v m �' •--------------------------- ------------------------------ -------------- ----•------------ --• -------------------------------------------------•--------------------------y----•--------------------------------------------------•------------ ----------------------------------------------•----------- ---- 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. a (Signed)--------------------- ---------------------------- -------•----------- - - - --------- --------- --------- ------- -( tractor] - caner a r By:.- r '-Y1 ` (Title} (Plot plan, showing size of lot, location of system in relation to wells, y � buildings, etc., can be placed an reverse side). • FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY_______ II ------------ DATE REVIEWED BY------------------------ --------- -- - ---�--�- ---J--�----------- ----- - ---------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------ ------------ ---------------•------------------------- ---------- ---------- --------- --------------- DATE------�---------- -•-----� A terations and/or recommendations:-------------- ------------------------------- ------ g -- / ~ FINAL INSPECTION 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 W-52 Revised W-2100