6587 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. _4-. /- (Complete in Duplicate) 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 JdJCATION__,_. •�� C // � _� //�! / ---------- Owner's Name----------LrLiC ' --------- � 1�1!t = Phone ------------------------------------------ -- ----------••---- Address.- � � ------------- Contractor's Name t: z � " : ---------- -------- Phone-21/0---Z2-•---- -� Installation will serve: Residence ❑ Apartment House ❑ Commercial Z, Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _.....-_..................... -----•-•---------------------- Water Supply: Public system 4 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ r TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public--sewer is available within 200,feet.) Septic Tank: Distance from nearesr well fl��. � _Distance from foundation__._..-...._ ----- ....___.__-- .......�r ... .. [� No. of con-apartments...- ----- --- -------------Size.:,�_7.A_fZ,-_ _7-Liqurd depth...../n_.-C� ------------ Y----- Ca acit -o---- P " a Disposal Field: Distance from nearest well---A/�,V�-Distance from foundation-__-4�p-s-_--..Distance to nearest lot line.../_4 ,� -- -----r-----Width of trench------- `t' ❑ Number of lines---------------- ---------�_� --Length of each line------------__L� •� Type of filter material _ _------Depth of filter material....-.1.`?.. -------Total length---------;-=$ ---------------.-----•-- r Seepage Pit: Distance to nearest well----/r-D_nf�_-.Distance from foundation__�VC9.._-.....Distance to nearest lot line-Z -------_-Number of pits...--c- --..------Lining materiameter_-.-. .- f---- .Depto------ �--� 7 � Cesspool: Distance from nearest well from foundation--------- ---------.Lining material---------------------- ❑ 5ize: Diameter Depth --------------- -----------------Liquid Capacity- -----------------------gals. Privy: Distance from nearest well------------------------------ ---------------. Distance from nearest buildin g --------------- ❑ Distance to nearest lot line = ----- - ` Remodeling and/or repairing (describe):---------------------- - --------••--------------------------------•---------------.;: ---------------------------------•---------..-..-----•------•- ----------------------•--------------------------------------------...-------------------------••-----------------------------------••----------------------- ------------------------------•-•-----•------------------------ 7 - --ere -• - --- ---------------------------------•-----------------------•--•---------------• ----------------- ------------ V ' I hereby certif, + 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State/(aws, and rules and regulations of the San Joaquin Local Health District. 7 5i ned y f� / G -�G�'.--�-;�-/-------- ------------------- -------------••-------------.(O ner and/or Contractor) Fir (Plot -(Title-- plan, showing size of lot, location of sys+em in rale+ionto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE.ONLY c APPLICATION ACCEPTED BY--------------- ----- ---- -- - - ----------------- DATE------- - --.- -------------------------------------- REVIEWED BY DATE BUILDING PERMIT ISSUED,------------------------ -- -ZZIF� ------------ DATE-------------•--- Alterations and/or recommendations:-------.---------- ------ ---------------------- ----------------------------------•--------- ----- -------•- r. - FINAL INSPECTION B -- 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 *k ES-9-2M Revised W-2100 -