6712 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. .__fP-- _ - . (Complete in Duplicate) / Date Issued Applica+-ion is hereby made to the San-Joaquin Local Health District for a permit to construe an install the work here-in describe This application is made in compliance with Count Ordinance No: 549. ` 07L 'JOB ADDRESS AND ATI N------ ---- _- - ------- - U, Owner's Name---------- ---- = ----------------------------------- --- ------ - 1_77!7. A - Address.------_—___rte` 7 ------ ' •-----... i ---------------------------- Li? Contractor's Name------ �.- •-•-•-4� _ --------------------_---------------------------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .-/___ Number of bedrooms ,', __ Number of baths _�--- Lot size ___ -�S-------- __ ----------------------------------- Water, Supply: Public system' K Community system E] Private ❑ :Depth to Water ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No is. New Construction: Yes 03� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank'or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ e' -,Distance from foundation_____ ___.. /t� No of compartments------c�______________Size___-',) Liquid depth------4_0_..........Capacity___:__- ��1____ Disposal Field: Distance from nearest well__ !V� 1RDistance from fcundation__.__/f_,------Distance to nearest lot line-1s�P...-- Number of Jines______,____- I Length of each line__._______ Width of trench------- __ ___ r �' /r g Type or filter material-:Jt---------��'"__t?!Depth of filter material__ -`__________Total length_________ ___ s?_-___-___. 4 s- Seepage Pit: Distance to nearest well___, $�c�,2Dkstance from foundation____: .�GF____._Distanee to nearest lot li©--r------------- Nu �'-________ [+ I�umber of,pits---------- ---------Lining material__C. Ak& Diameter____3 -----------.Depth---�-------- -------------- Cess bol: Dista ce from ter nearest Well------------------ from foundation--------:--____-.__Lining material._____________-,______-______________- p ❑ p r--:----Liquid Capacity-----------------------------gals. Privy:'_ Distance from nearest well ____.---------_---------------------------------------Distance from nearest building-----------------------.______________._. ❑ Distance to nearest lot line_______________'__£-______ -i "• ----------------------------------------- - - ; .4 Remodeling and/or repairing (describe)----------------------------- x-- ---- 6Z--------------•------------------------ --- = ------•-- -------------------- - -------- ---------------------------------•-•---••••-• ----•---------------------------------------------------------------•-------------------------•---•----------------------------------------- ________________________________________________________________________________________________________________________________---__________________-___-__________---___________-____--._______________-______--___-__-__.___ I hereby cerci that l have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, Sta la s, and rules and regulations of the San Joaquin Local Health District. �_ _ ` Ow or and/or Contractor (Signed)..-- = -------------------------------------------....---------- ( I By � --------------------------------Tale (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---------->_------------------------------------------ REVIEWED BY--------------------------------------------------------- �,-'O - DATE-t ----------h--- - ------ ----------- --------------------------------------- -•----------------------••--•-------- BUILDING PERMIT ISSUED--------------••--------------- ------ ----- -- -- ---'------ ----------------------------=-----•-- DAT E.--N------------ --- Alterations and/or recamm dations: \\`a... ----------------------- ------ ---- ----- = _____________________________ ________ _________ _ __ _ _____ 0 _^_--__-_--__--____-._- _ -_-.___.-_________-____.-__....__. ..........Z. --•------------------ -C)------- ------- :`; •-------...-----------. I--------- --------------=--•-------------- FINAL INSPECTION BY:.-- " -- -- - ----------•----- •--•----------• ---- Date._ 0_---------- y �� --------------••---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+rest 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100