6178 - Laserfiche WebLink

Home Browse Search

`� APPLICATION FOR SANITATION PERMIT Permit No. ...�__l_ (Complete in Duplicate) w 3� _ ti Date Issued 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 LOC ION....---1. ------ ---------•�(____-�'e'�!�------------L- --------�-- a"'`�`' Owner's Name------------------- Address......... ---- =-'.1� ------ l$� �_la_d ,17 ...... .Q l z Phone Contractor's Name-------- ----•- ------ -----• Phone------------------- 1` ' �� Installation will serve: Residence 2-<Partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Ia Number of living units` __1___._ Number of bedrooms ;L- Number of baths __).-._ Lot size _ D___ _______/�__—_____________________________ Water Supply: Public system A—iff-ommunity system ❑ Private ❑ Depth to Water Table -------- ft. ' Character of soil to a depth i f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑_�e Previous Application Made: IYes ❑ No Er-IN_ew Construction: YesNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance rom nearest well. _-_-Distance from foundation-_./_Q..__._.._..Material--------------------- No. of chmpartments-----:---�------------Size..�_fCs._X_�----------Liquid depth---�7.�_� -........Capacity.__.��--d--_-- Disposa field: Distance I`rom nearest well�'� .-_Distance from -Q foundation ---------Distance to nearest lot line_-___----__.._-- Number of lines---.------e�--------- -------Length of each line_ '_ . --_.Width of trench_---- --- ---. 1 Type or filter material___,'l.wc .....Depth of filter material----t'?------------Total-len gth------- ---------------------- 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-__-_.--------_-_ ❑ Number of pits ------ -------------Lining material-----------------------Size: Diameter--------------!--------Depth--------------------------------- 1A Cesspool: Distance`from nearest well--------------__Distance from foundation--------------------Lining material----_--._-------.-.-.._---__---_-----. Size: Diameter--- ------------_---- -----------.De th----------------------------------------------------Liuid Capacitygals. Priv Distance,from rearest well----------------------------------------_-.--.-_Distance from nearest buildin -_----. V ❑ Distance'to nearest lot line._------.__---__._____-..-_._ i' Remodeling and/or repairing (describe):----------------------------------------------------------- ----------------•---•----------------- -----•-- ------------------------..........-......... -----•---•-----•-•-------------------------------`- --------------------------------------------------------------------------------------------------------•-----------•--•------------------------•--- I IM I hereby certify th I have p red this application and that the work will be done in accordance with San Joaquin County ordinances, S e I ws a d r,'ules regulations of the San Joaquin Local Health District. ' .r n Owner and or Contractor (Signed]- ---- ------------•-- :------� -��----- -- { / I BY-----------------------------• I {Ti+le)-- (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 t APPLICATION ACCEPTED 13Y „` ------------------------------------------------- DATE / REVIEWED BY------------------------------------------- --------------- DATE- ---------- BUILDINGPERMIT ISSUED 1` - ----------- -------------- - ------- ---------------------DATE------------------------J•------------•--------------------- Alterationsand/or recommendations:---N ------------------------------- --- - --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- --------- ------------------------------------------------------------------------------------•---•---•--•------------•--•------------------------------------ --------------------- --•-----------------------I---•---•-- ---------------------------------- -------- -------------------------------------------•-••-------•••••----------------------------------------------- ----------------------•----------•---------------1M---------------------•- --- -------------------------------------------------------------------------- -------------------------------------------1----------------------- I FINAL INSPECTION BY:- T�c.�3S Date ----5 --------- --------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 300 West Oak Street 132 Sycamore Street 814 north "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I J E3--9-2M 345446 ATWODO 12-54: f16 i 3�