4235 - Laserfiche WebLink

Home Browse Search

i APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued A Thipplication is hereby made to the San Joaquin Local.Health District for a per s application is made in compliance with County rmit to construct and install the work herein described. 4u F No. 549, JOB ADDRESS AND L C TION."_ Owner's Name---------__. ----------- -0� 4- Address ---------- ---------•---_-•_-- ------------------------------------------ Phone------------ Contractor's Name ------------------• - -------•--------- ---------- --=---. ------ Phone Installation will serve: Residence 'Apartment _ r, ❑ House + �� ' ❑ Commercial ❑ Trailer Court [] Motel ❑ Other 2,*4' Number of. living units: _�---- Number of bedrooms ,0--_ Number of baths J 11.1t, s ----- Lot size _-�-DQ---�- --�-�--�---------.. . Water Supply: Public system ❑ Communit system Y Y ❑ Private ❑ .Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [] � Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan E] Previous Application Made: Yes ❑ 'N i['9 New Construction: Yes (j No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--"/ � Distance fr fon ron_r- _- 41 11'fce�3l rt ��--_ Materiel L " [+ ® No, of compartments-------- --_ i i ------------ $,ize_ .Ii ,'�-----.Liquid depth-------14/-- - Disposal Field: Distance from nearest well-"_..' --.__Distance from foundation_--''_,_ Capacity---"_" d Q _._._..Distance to nearest lot line_--_"- ___ ® I Number �oi lines-`-`-'-"-"°_1�'_- " Length of each line--------- U ___ i. -- Width of trench----Z �� .......... Type of filter material"- -- �_ e --Depth of filter mater al - /- - Seepage Pit: Distance to nearest well_--"_�" Distance from„f undation__- --� ]Total lengtt= _• ._le--_�-__________ " Number of pits- Linin material--�► - / .a; e to ,,x� x Dia`nc nearest lot Ian ��(� g Size: Diameter- { - -..• A Cess ool. # „_; 4 • v �_ .. , ------- ------ El Distance from nearest well--_-_----_-_--_Distance from foundation_---- �"i"_.LininY-g a}erial .- "-- _:__: - = _-------- Privy; # ❑ I Size: Diameter -----------------------------Depth--------------- ----- ».. -- --- ----- ----- - ------Liquid Capacity--------------------------- gals.Privy: Distance from nearest well + _ g _"-.- f_-Distance from nearesf buiiding__--__-. ❑ Distance to nearest lot line__-- !___-_-- -- iLit f ---------------------------------t 4AW_ __ . ---------------------------- ordinances. ytate laws and r l4aiegulafionsp si ---- - ------- ----------------- I hereb certif that I have re ared this applicationtand that thework will be done in accordance with San Joaquin Count of theSan Joaquin Local Health District. Y(Signed '.-92 A14 . -- -- -- -------------- (Owner and/or Contract � - -- d/o or] --------------------------------------------(Title)_ - ----------------- (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can�be placed on reverse side}. s FOR DEPARTMENT USE ONLY b APPLICATION ACCEPTED BYPill _--...-"-- aC ---- - ------- - ---- -- ----- -- DATE . REVIEWED BY BUILDING PERMIT ISSUED 4 - --------- ---------------------- DATE Alterations and/oi recommendations:-- -- ----_- f I ------------ DATE------ -------------------- -- ----- --- -- --------------- ------------------------------------- - --------------------------- FINAL INSPECTION BY:. ------ - ate `" ` --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132'Sycamore Street 814 North "C" Street Stockton, California Lodi, California r,lvlanteca, California Tracy, California ES-9-2M 10-52 Revised W-2100