5422 - Laserfiche WebLink

Home Browse Search

li APPLICATION FOR SANITATION PERMIT Permit No (Complete in Duplicate) Z. Date Issued - -----•-------- Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo herein described. This application is made in compliance with C my inai ce 549, t JOB ADDRESS A D LOCATi Owners Name------ ��!1_ -- - --- - -- Ph �9 Address------------------------ ------- Contractor's Name--------- °.�C�i!''�rh5 - Ph (� ----- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other ❑ y } Number of living units:,. ---- Number of bedrooms --Number of baths _-�- Lat `size _--� r �o----�./�-o----=-------------- Water Supply: Public systerri``� Community system'[] Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe% Hardpan ❑ Previous Application Made: Yes ❑ No, New Construction-:-YesJC'No ❑ I f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic+ank.or cesspool permitted ifpublic, wer is available within 200 feet.). Septic Tank: Distance from nearest well- Distance from f _�-Q- oundation_ - ---" •---.Material---An --- No. of compartments-.__�__ Size_ �� - �_ -Liquid depth-__�%__!!---------Capacity- - -.-- _-Q------- x -r' Disposal Field: Distance from nearest welt- __-----____ Distance from faunclation-_/.Q- -----Distance to nearest lot line___---�. Number of lines-1---------- Length of each line----1________-___"- Width of trench. T----r( �! �s .r Type of.filter material-- -� --� __--Depth of filter.material-___--/ --- -Total length------ ----------------rl e�. c•;!- yl. .� . Seepage Pit: Distance to nearest well !jistanc----f-_r_-- oun- antaace to neareh-s-t lot line--- Number of pits --------------Lining mate --__----_.-.MaSize: Diamete ---- .. ept _ --' -------_--_- Cesspool: Distance flIom nearest well------------------Distance from foundation---------------__...Lining material------------------------ --------- ❑ Size: Diamter.- } "= : ------------ Depth ---------- Liquid Capacity- --------------------------gals. Privy: Distance from nearest well---------- -:--_______---------------------Distance from nearest building -------------- FT Distance to nearest lot,line--- -- -. Remodeling and/or repairing (describe): --------s---------------------------------------------------------=------- -------==-------•--------- -----------------••---------- -------•----------•----------------•------=-- -------------- ----------------------------------------------------------- - 4 ------------------------------------------------------------------+_._-.__.-______-. C . - C___-_-- -_ _ ., . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,4Ta aws, rules and regula fans +h J9oaquin Local Health District. t (Signed)- :--------- �"._�� J J --------------- ---- ------- ------------------------------ Contractor Plot plan, showing size c I B ------------------------------------ r--- ----------•------------------ ----- - Title._. �y [ p g of lot, Boca+ion of system in rel io o wells, building etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BYIh REVIEWED BY - DATE-------- ------------------- BUILDING PERMIT ISSUED l -------------------------------- ----- ------------- ------------- .. DATE------------------------------------- ------------------------------------------------------------------------- --------f------•-- DATE----------------------------- ' Alterations and/or recommendations:------_c----------------------------- ------------------------------- l--------- '_�_: �.��:� -----'�--- ' ,�+�"" !� K -------------------. --- ---- - - -_----------------------- ---------------------------------------------- ----- -- ---------------------------------------------------------------------------------- ---------- -- --- " - j 3 �,. FINAL INSPECTION BY: a---------------------------_---------=--• - --- Date-: " - -------------------------------------------- 'l SAN JOAQUIN LOCAL HEALTH DISTRICT it 130 South American StreetI 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100 I i