5289 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. ----- - _-__-rr__- (Complete in Duplicate) _ Date Issued ------ 7_. 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------_>�.7. - ---.-_------- ----- - -------- ------- - -- � '" Owner's Name------------ -..___-V ._._. Phon - - --�' d!_�.- - ___.._. ._ Address------------------_-- TJ ' -------- -------------------------------------- ------------------------------------ Contractor's Name_____________ _ I ql, 7 ----4----------- ------------------- -{!�y+�..�-------------�------------------------------------------._ Phon -- -. _.�_'-r.!�-�-,! Installation will serve: Residence 2--'Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I If X___& } Number of living units: __/__ Number of bedrooms _cL_ Number of baths ---/.. Lot'size _71S------- _____________________ Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table _'yig ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [?4-�New Construction: Yes ❑ No6 , TYPE OF INSTALLATION AND SPECIFICATIONS: ' .v (No septic tank or cesspool permitted if public sewer is available within 200 feet.); Septic T nk: Distance from nearest well-----------------Distance from foundation_____________':___Material______.______________-_._______________.__.__--. E] No. of compartments ---------- ------- ----Size---------------------------- ---Liquid dept--------------- - --------Capacity----------------------- Disposal Field: Distance from nearest well___________ _Distance from foundation-----Jd--------Distance to nearest lot line_____,____ `dumber of lines___.._:_____/,. _.T�_ Length of each line----- �� Width of trench---m�Y�� J Type of filter material� ___Y __Depth of filter material___.__l�_____:----Total length_________ '�_-d________________________ f Seepag ' it: Distance, to nearest well-______ "____Distance from foun ation_____ v_._..Distance to nearest lot line_______.__ ( Size: Diamefer-- -De to--- Number of pits______-_t ______-_Lining material_.�..�__ __ p ' I Cesspool: Distance from nearest well-----------------Distance from foundation______________'-----Lining material_.___________-._______.__.__.___. Size: Diameter_______________________- ' ❑,. ------------Depth----------------------------------------------------Liquid Capacity------------ ------------gals. } Privy:. Distance from nearest vrell_________________________________.___________._Distance from nearest building__-___-___.__._________________-_-___._._El . Ir _ _.s.�. Distance to nearest lot line------------- --`-------------=----------------•--------------------�--------'------------------------------------------ Remodeling and/or repairing (describe) -------------------------------------------------------•----------------;_------------------------------------- ---------------------------------------------------------------- ..--------•----•-_------- ------------------•-----------•----------- - --------------- ------------- ------ -------------------------•----------------------------------------------------------------------------------------------------------------------------------•------------------------ -------------------------- ____________________ 4 � � _ __ __ _ ____________ __________________________________________» .. _._____._________.._ ___-___.____-__.-..___--.-_____-_-__..-________.»_________._____________________._.__.- ______ ___ _ __ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law d rules and regulations of the San Joaquin Local Health District. w:: I (Signed) ------------- --- -�`/C -and/or Contractor) R , By:........... ................. -------- :------------------------ ------------------ (Title] -------------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can.be placed on reverse side). i ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------------------------------- --- ------------------------------------------- DATE----------- r . y---------------- - REVIEWEDBY----------------------------------- ------------------------------------------------------------------------------------------ DATE-_----------------------------• ----------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------- •----- ------------- -- DATE-------------------- =-------------------------------------- Alterations and/or.recommendations:--'---------------------------------------------------•-----------------------------------.-----------------------------•---------------------------•------- ---------------------------•-------•-----------------------------------------------------------------------••------------------------•--•--------------------------------•--------.----------------------------------------- ---------------------------------------------------------------------•-------- ----------------- ----------------- -----------------------------------------------------•------------------------------------------- ...... I -•-•--------------------------- --------------------------------------------------•----------------- --------------------------------- ---------------------------- ----------------------------------------------------- ----------'------------- --------- ------- -------------------------•--------- -------------------------------•------------------------------- ----------------------------------------------------------------------------- g ryJ� G FINAL `INSPECTION 'BY:-------"--------------- :rl - ' - 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 Revised W-2100 f`