5399 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit N . .} (Complete in Duplicate) �-7 Date Issued /___"_a_�------'1. Applica-&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 County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- D7 """" ------------ -----------•---------- --------•------------------------.------- Owner's Name---- 2t1-, t-s...... �' /7- 'n `s------ r- Address.... __. Qa_L.�_ I 3 -�� ---------- - one caL Contractor's Name = /CU t o - er 5� 1.JE .Se l�V c -----•--•- 1! # Phone--"�°•- y-�.'Z 4 ;. ------------------------ Installation will serve: iResidence [B' Apartment House ❑ JCommercial ❑ Trailer Court [] Motel ❑ Other Number of livm units: _ k ._ g _/-__ Number of bedrooms _ _--_ Number• of baths!--- Lot size -__"_-�S"o' /. J '""" Water Supply: 'Public' Q� Community system ❑ Private ❑ Depth to Water Table �/ eft.jI } Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Adobe Y ❑ Y ❑ Y ❑ [ Hardpan ❑ Previous Application Made: YesNo{ E ❑ �D�New Construction: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 f k (No septic fank'or cesspool permitted if �+ p p public sewer is available within 200 feet.) eptic Tank: Distance from nearest;well--__:4__tDistance from foundation--------------------Material ____-_____-______ � ------ No. of compartments'-------- ------Size--------------------------------liquid depth Capacity i --- -------------------- .. Disp^os'al Field: Distance from nearer well-lip Wim[!-_Distance from foundation--3R!---------Distance to nearest lot line___:r"""" L7 TypeNumor it lines_-_}_. ___----" _.W------__-'Length of each line___ 34_'___._.---"'____--.Width of trench-.-__i .� Type of filter materia.I _-kAA*____-SDepth of filter material_'-_J8"°'-_-____-_ 0 � � ] Total length------ 3------------------------------- _ Seepage Pit: Distance to neatest weil_XR—.eJa..11__ Distan dation_._�v.___ Di S N Y _ : # stance to nearest lot line__"____#_____. L� Number of pits Lining a rial_ -----. .Sized Diameter----32--------------.Depth--- r-- -~f Cesspool: Distance from nearest�well________________Dis ation___._-___----._.___.Lining material__-_-_._. ~"" "__ ` ------ El . � - -------Liquid Capacity-------------------- - Size: Diameter------------------------- --------Depth:------- --------=----------------- �-- -- -----gals. Privy:' Distance from nearest well--- -",_---------__-_____Distance from nearest buildin _ g - .. ❑ - � Distance to nearest lot line---------- ,. Remodeling and/or repairing {clescribe)-----------_---------------------------------------------------------------------------------------------------- - ---•-----•----- ----------- ---------••------• ---------- -•--------------•---------------- --------------------------•----------- --- ----------------•--------•-------------------------------------------------------------------------•-------------•-----------•------------------------------------- ------ S i � " --------------------------------------------------------- r I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).----- �f !1. t e,r" S-'r_GJ 'S /-#1 l- r" 0 n_ }a a 1 �! _____________(Owner and/or Contractor) BY:------••-------r -------wt-t7 Title. `S2/+es 1 i (Plot-plan, showing size 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-----------� - j REVIEWED BY-------------"--" - - ------------------ -- ------ ---------- DATE-- BUILDING PERMIT ISSUED--------------------- -- Alterations and/or recommendations:-______._-._ --------------- ----•----------------"-----•---------"-------••-----••---------------------------------- ------- -------------- ---------- -------- ] I F1NAL 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 -9-2M Revised W-2100