5869 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERM T '� VPermit No.CJIV_C�___ _�r. (Complete in Duplicate) Date Issued Applical-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 OCA ON-,.-- -- - — `y'� •t.C� �-! ALL ,+GG•j�pJ, s. .� --;-_--r Owner's Name ' -4---- •---------------- -------------- Phone �j Address----------------- _ ."?"."" __* L� .t � -- --- ------------------------------• -----------------•--------------------------------------- Contractor's Name--------------------- --------- --------------------------------------------- -------------------------------•---------- ----------------- Phone " ---------• Installation will serve: Residence! Apartment House E] Commercial ❑ Trailer Court E] Motu, El Other Number of living units: ""!---- Number of bedrooms _f*.r Number f baths ----/,4Lot size _--T -- _ r� -A -------------(�_-- -------------------•- Water Supply: Public system E] Community system [IPrivate Numb to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No E❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu4,liicc,seww is available within 200 feet. ' Se ank: Distance from nearest wells r"'"__Distar_ce fro f undat' n--- V *7' Seprel rq toMater a�No. of compartments +-----• 5zer I -- Liquid Flepfh CapacitY,,�,-J - DisV Field: Distance from nearest weli�;� ____--" ;stance from foundation PL7?t4 .Distance to nearest�t dime Number of lines---------- _-- --Length of each line------------------- - Width of trench---_-__-- -- ' rf /------------ Type of filter mater; epth of filter material------_L�'.___--.-Total length___-__"-----_- "��________" Seepage Pit: Distance to nearest well----------------------Distance from foundation------.-------------Distance to nearest lot line-----_-__-_---_- ❑ Number of pits----------------------Lining material------------------J----Size: Diameter---- -- --Depth-----------------____-- Cesspool: Distance from nearest well-----------------Distance from foundation----_.-___-----.--- Lining material-__----_-------_____--.--__ El Size: Diamefer-------------------------------------- ! ---_Li uid Ca Capacity Depth-- 9 P Y---------------------------.gals. Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building ❑ Distance to nearest lot line IZemodling and/or repairing (describe -------- -4-14---Z? --------------------------------------------------------------- ------------------------------------------------------- - ---- --------/_-_ -- "--- -------T --- t r--•-------------------••------------------------------ ------------------------------------ -------------------------•--------•----------- ----------•------------------------•----------•-------•--•----------------------------•------------••---------•------- -------- 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 he San Joaquin Local Health District. (Signed ---------- ----- -s ----------------- --------------------------(Owner and/or Contractor) By:. ---------------------------------------- -------------------- ------- --- -------4----------------------(Title)--------------------------•---------------------------------- (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------------------------------ DATE- _ BUILDING PERMIT ISSUED----------- ----------------------------------------•-------------- ------- --•--- DATE--- ---------- - Alterations and/or recommendati�s:-------.------------- -- ---------------- ------- ------------ ------ ---- �.--- ,..r. - ------------ --------- FINALINSPECTIONBY----------------------------------------------------------------- Date--- - ----------------------------------------------------------------------- SAN ------------------- - - 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 E5-9—2M ; . Revised W-210D